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: PURPOSE To compare the efficacy of behavior activation ( BA ) + low vision rehabilitation ( LVR ) with supportive therapy ( ST ) + LVR to prevent depressive disorders in patients with age-related macular degeneration ( AMD ) . DESIGN Single-masked , attention-controlled , r and omized , clinical trial with outcome assessment at 4 months . PARTICIPANTS Patients with AMD and subsyndromal depressive symptoms attending retina practice s ( n = 188 ) . INTERVENTIONS Before r and omization , all subjects had 2 outpatient LVR visits , and were then r and omized to in-home BA+LVR or ST+LVR . Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals . Supportive therapy is a nondirective , psychological treatment that provides emotional support and controls for attention . MAIN OUTCOME MEASURES The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Question naire-9 ( primary outcome ) , Activities Inventory , National Eye Institute Vision Function Question naire-25 plus Supplement ( NEI-VFQ ) , and NEI-VFQ quality of life ( secondary outcomes ) . RESULTS At 4 months , 11 BA+LVR subjects ( 12.6 % ) and 18 ST+LVR subjects ( 23.4 % ) developed a depressive disorder ( relative risk [ RR ] , 0.54 ; 95 % CI , 0.27 - 1.06 ; P = 0.067 ) . In planned adjusted analyses the RR was 0.51 ( 95 % CI , 0.27 - 0.98 ; P = 0.04 ) . A mediational analysis suggested that BA+LVR  prevented depression to the extent that it enabled subjects to remain socially engaged . In addition , BA+LVR was associated with greater improvements in functional vision than ST+LVR , although there was no significant between-group difference . There was no significant change or between-group difference in quality of life . CONCLUSIONS An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to st and ard outpatient LVR in patients with AMD . As the population ages , the number of persons with AMD and the adverse effects of comorbid depression will increase . Promoting interactions between ophthalmology , optometry , rehabilitation , psychiatry , and behavioral psychology may prevent depression in this population Background The prevalence of depression in people with a visual disability is high but screening for depression and referral for treatment is not yet an integral part of visual rehabilitation service provision . One reason for this may be that there is no good evidence about the effectiveness of treatments in this patient group . This study is the first to evaluate the effect of depression treatments on people with a visual impairment and co morbid depression . Methods / design The study is an exploratory , multicentre , individually r and omised waiting list controlled trial . Participants will be r and omised to receive Problem Solving Therapy ( PST )  , a ‘ referral to the GP ’ requesting treatment according to the NICE ’s ‘ stepped care ’ recommendations or the waiting list arm of the trial . The primary outcome measure is change ( from r and omisation ) in depressive symptoms as measured by the Beck ’s Depression Inventory ( BDI-II ) at 6 months . Secondary outcomes include change in depressive symptoms at 3 months , change in visual function as measured with the near vision subscale of the VFQ-48 and 7 item NEI-VFQ at 3 and 6 months , change in generic health related quality of life ( EQ5D ) , the costs associated with PST , estimates of incremental cost effectiveness , and recruitment rate estimation . Discussion Depression is prevalent in people with disabling visual impairment . This exploratory study will establish depression screening and referral for treatment in visual rehabilitation clinics in the UK . It will be the first to explore the efficacy of PST and the effectiveness of NICE ’s ‘ stepped care ’ approach to the treatment of depression in people with a visual impairment . Trial registration IS RCT Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Depression is among the most prevalent and burdensome psychiatric disorders in the United States ( Kessler et al. , Achieves of General Psychiatry 62:617 - 627 , 2005 ) . There is substantial empirical support regarding efficacy of pharmacotherapy , psychotherapy , and combined treatment ( both pharmacotherapy and psychotherapy ) for treating depression . However , far less is known about the effectiveness of these treatments for real-world patients treated within routine clinical care setting s ( Cahill et al. , The British Journal of Clinical Psychology 49:421 - 453 , 2010 ) . This study seeks to explore the effectiveness of treatment as usual ( TAU ) for depression in a large cohort of psychiatric out patients receiving psychotherapy , pharmacotherapy , or combined treatment within an academic medical center . Initial and follow-up self-report assessment s were analyzed for 1,322 patients receiving treatment for depression . Using these data , we determined treatment effect sizes , rates of reliable improvement ( and deterioration ) , and rates of clinical ly significant improvement for psychotherapy , pharmacotherapy , and combined care . On average , all treatments produced significant improvement with effect sizes surpassing our no-treatment benchmark . No significant between-group ( treatment ) differences in self-report outcomes were found . The rates of reliable change were similar for all treatment groups consistent with past research . The present findings support the effectiveness of psychotherapy , pharmacotherapy , and combined treatment as routinely provided within a large academic medical center for the treatment of real-world patients suffering with depression OBJECTIVES To assess the effectiveness of a self-management program for age-related macular degeneration ( AMD ) in reducing depressive symptoms . DESIGN Analysis of 6-month follow-up for a subset of participants in a r and omized , controlled trial who were clinical ly depressed at baseline . SETTING University ophthalmology clinic . PARTICIPANTS Thirty-two depressed older adult volunteers ( mean age 81.5 ) with advanced AMD who had been r and omized to a self-management program ( n=12 ) or one of two control conditions ( n=20 ) . Subjects were included if at baseline they met criteria from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders , Axis , I , Fourth Edition , Research Version , for major or minor depressive disorder with significant depressive symptoms ( > or=5 points ) on the 15-item Geriatric Depression Scale ( GDS-15 ) . INTERVENTION AMD self-management program consisting of cognitive and behavioral elements including health education and enhancement of problem-solving skills . MEASUREMENTS Primary outcome measure was GDS-15 . Secondary outcome measures included National Eye Institute Visual Function Question naire ( NEI-VFQ ) and AMD Self-Efficacy Question naire . RESULTS At 6-month follow-up , the self-management group had a significantly greater reduction in depressive symptoms on the GDS-15 than the controls ( P=.03 ) . The mean reduction of 2.92 points in the self-management group was more than the 2-point change threshold considered to be clinical ly meaningful . Change on the NEI-VFQ was nonsignificant . Reduction in depressive symptoms was associated with greater self-efficacy in the self-management group . CONCLUSION These findings may support the effectiveness of an AMD self-management program for depressed older adults with advanced vision loss from AMD OBJECTIVES Age-related macular degeneration ( AMD ) is a common , disabling disorder of older age that is associated with depression . We investigated the incidence rate of depression and its risk factors and consequences in this 6-month longitudinal study . DESIGN A prospect i ve cohort study in which subjects were interviewed 6 weeks after the onset of bilateral vision loss and 6 months later . SETTING The sample was recruited from the retinovascular clinic of a specialty eye hospital . PARTICIPANTS Subjects were 51 patients with new onset bilateral AMD . MEASUREMENTS We assessed depressive symptoms , personality traits , visual acuity , and vision and physical functioning . Additionally , we interviewed informants to obtain independent assessment s of subjects ' personality traits . RESULTS The baseline prevalence rate of syndromal depression was 23.5 % and high levels of depressive symptoms persisted over time . The 6-month incidence rate of depression was 27.8 % . The strongest risk factors for incident depression were self-rated and informant-rated neuroticism . Patients who developed syndromal depression were 8.3 times ( 95 % confidence interval = 1.1 - 63.4 ) more likely than nondepressed patients to become disabled in vision function , independent of change in visual acuity . CONCLUSION AMD is associated with high rates of depression and visual disability independent of severity of vision loss . The personality trait of neuroticism is highly predictive of incident depression and identifies patients at high risk for excess disability . Psychotherapeutic treatments targeted to this group may prevent depression and reduce disability PURPOSE To investigate the association between visual impairment and depression and anxiety in older people in Britain . DESIGN Population -based cross-sectional study . PARTICIPANTS Thirteen thous and nine hundred people aged 75 years and older in 49 family practice s in Britain . METHODS Vision was measured in 13 900 people aged 75 years and older in 49 family practice s taking part in a r and omized trial of health screening that included depression ( Geriatric Depression Scale [ GDS-15 ] ) and anxiety  ( General Health Question naire [ GHQ-28 ] ) . Cause of visual impairment ( binocular acuity less than 6/18 ) was assessed from medical records . Analysis was by logistic regression ( odds ratio [ OR ] and 95 % confidence interval [ CI ] ) , taking account of potential health and social confounders . MAIN OUTCOME MEASURES Levels of depression and anxiety . RESULTS Visually impaired people had a higher prevalence of depression compared with people with good vision . Of visually impaired older people , 13.5 % were depressed ( GDS-15 score of 6 or more ) compared with 4.6 % of people with good vision ( age- and gender-adjusted OR , 2.69 ; 95 % CI , 2.03 - 3.56 ) . Controlling for potential confounding factors , particularly activities of daily living , markedly attenuated the association between visual impairment and depression ( OR , 1.26 ; 95 % CI , 0.94 - 1.70 ) . There was little evidence for any association between visual impairment and anxiety . On the GHQ-28 scale , 9.3 % of visually impaired people had 2 or more symptoms of anxiety compared with 7.4 % of people with good vision . CONCLUSIONS Although cause and effect can not be established in a cross-sectional study , it is plausible that people with visual impairment are more likely to experience problems with functioning , which in turn leads to depression & NA ; Studies of the psychosocial aspects of visual impairment have emphasized the effects of blindness , giving relatively little attention to the effects of mild or partial visual impairment . Consequently , we know little about when in the course of visual loss significant psychosocial dysfunction develops . To address this question , we assessed psychosocial functioning at three times over eight months in 31 adults with proliferative diabetic retinopathy and mild to moderate visual impairment in at least one eye . Examination of the correlations between visual and psychosocial measures revealed strong and significant correlations between visual acuity and adjustment ( range of r = ‐0.45 to ‐0.68 ) , between visual acuity and psychological symptoms ( range of r = ‐0.39 to ‐0.50 ) , and between visual acuity and emotion‐focused coping ( range of r = ‐0.38 to ‐0.53 ) . The strength of these correlations and their occurrence in three independent measures of psychosocial functioning suggest a clinical ly meaningful relationship between visual and psychosocial functioning in the range of mild to moderate visual impairment . Psychosocial dysfunction related to visual impairment develops long before blindness . Further prospect i ve research on the psychosocial aspects of partial visual impairment will clarify this relationship and may help justify early intervention with rehabilitation in the visually impaired who do not qualify for services for the blind PURPOSE In addition to performance-based measures , vision-related quality of life ( QOL ) and other subjective measures of psychosocial functioning are considered important outcomes of training in the visually impaired . In a multicenter , masked , r and omized controlled trial , subjective effects of training in the use of closed-circuit televisions ( CCTV ) were investigated . METHODS Patients ( n = 122 ) were r and omized either to a treatment group that received usual delivery instructions from the supplier combined with concise outpatient training , or to a control group that received delivery instructions only . Subjective outcomes were the low vision quality -of-life question naire ( LVQOL ) , EuroQOL 5 dimensions , adaptation to age-related vision loss ( AVL ) , and the Center of Epidemiologic Studies Depression scales . Linear mixed models were used to investigate treatment effects . Differential effects of patient characteristics were studied by implementing higher order interactions into the models . RESULTS From baseline to follow-up , all patients perceived significantly less problems on the reading and fine work dimension ( -28.8 points ; P < 0.001 ) and the 
    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: PURPOSE To compare the efficacy of behavior activation ( BA ) + low vision rehabilitation ( LVR ) with supportive therapy ( ST ) + LVR to prevent depressive disorders in patients with age-related macular degeneration ( AMD ) . DESIGN Single-masked , attention-controlled , r and omized , clinical trial with outcome assessment at 4 months . PARTICIPANTS Patients with AMD and subsyndromal depressive symptoms attending retina practice s ( n = 188 ) . INTERVENTIONS Before r and omization , all subjects had 2 outpatient LVR visits , and were then r and omized to in-home BA+LVR or ST+LVR . Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals . Supportive therapy is a nondirective , psychological treatment that provides emotional support and controls for attention . MAIN OUTCOME MEASURES The Diagnostic and Statistical Manual IV defined depressive disorder based on the Patient Health Question naire-9 ( primary outcome ) , Activities Inventory , National Eye Institute Vision Function Question naire-25 plus Supplement ( NEI-VFQ ) , and NEI-VFQ quality of life ( secondary outcomes ) . RESULTS At 4 months , 11 BA+LVR subjects ( 12.6 % ) and 18 ST+LVR subjects ( 23.4 % ) developed a depressive disorder ( relative risk [ RR ] , 0.54 ; 95 % CI , 0.27 - 1.06 ; P = 0.067 ) . In planned adjusted analyses the RR was 0.51 ( 95 % CI , 0.27 - 0.98 ; P = 0.04 ) . A mediational analysis suggested that BA+LVR  prevented depression to the extent that it enabled subjects to remain socially engaged . In addition , BA+LVR was associated with greater improvements in functional vision than ST+LVR , although there was no significant between-group difference . There was no significant change or between-group difference in quality of life . CONCLUSIONS An integrated mental health and low vision intervention halved the incidence of depressive disorders relative to st and ard outpatient LVR in patients with AMD . As the population ages , the number of persons with AMD and the adverse effects of comorbid depression will increase . Promoting interactions between ophthalmology , optometry , rehabilitation , psychiatry , and behavioral psychology may prevent depression in this population Background The prevalence of depression in people with a visual disability is high but screening for depression and referral for treatment is not yet an integral part of visual rehabilitation service provision . One reason for this may be that there is no good evidence about the effectiveness of treatments in this patient group . This study is the first to evaluate the effect of depression treatments on people with a visual impairment and co morbid depression . Methods / design The study is an exploratory , multicentre , individually r and omised waiting list controlled trial . Participants will be r and omised to receive Problem Solving Therapy ( PST )  , a ‘ referral to the GP ’ requesting treatment according to the NICE ’s ‘ stepped care ’ recommendations or the waiting list arm of the trial . The primary outcome measure is change ( from r and omisation ) in depressive symptoms as measured by the Beck ’s Depression Inventory ( BDI-II ) at 6 months . Secondary outcomes include change in depressive symptoms at 3 months , change in visual function as measured with the near vision subscale of the VFQ-48 and 7 item NEI-VFQ at 3 and 6 months , change in generic health related quality of life ( EQ5D ) , the costs associated with PST , estimates of incremental cost effectiveness , and recruitment rate estimation . Discussion Depression is prevalent in people with disabling visual impairment . This exploratory study will establish depression screening and referral for treatment in visual rehabilitation clinics in the UK . It will be the first to explore the efficacy of PST and the effectiveness of NICE ’s ‘ stepped care ’ approach to the treatment of depression in people with a visual impairment . Trial registration IS RCT Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Depression is among the most prevalent and burdensome psychiatric disorders in the United States ( Kessler et al. , Achieves of General Psychiatry 62:617 - 627 , 2005 ) . There is substantial empirical support regarding efficacy of pharmacotherapy , psychotherapy , and combined treatment ( both pharmacotherapy and psychotherapy ) for treating depression . However , far less is known about the effectiveness of these treatments for real-world patients treated within routine clinical care setting s ( Cahill et al. , The British Journal of Clinical Psychology 49:421 - 453 , 2010 ) . This study seeks to explore the effectiveness of treatment as usual ( TAU ) for depression in a large cohort of psychiatric out patients receiving psychotherapy , pharmacotherapy , or combined treatment within an academic medical center . Initial and follow-up self-report assessment s were analyzed for 1,322 patients receiving treatment for depression . Using these data , we determined treatment effect sizes , rates of reliable improvement ( and deterioration ) , and rates of clinical ly significant improvement for psychotherapy , pharmacotherapy , and combined care . On average , all treatments produced significant improvement with effect sizes surpassing our no-treatment benchmark . No significant between-group ( treatment ) differences in self-report outcomes were found . The rates of reliable change were similar for all treatment groups consistent with past research . The present findings support the effectiveness of psychotherapy , pharmacotherapy , and combined treatment as routinely provided within a large academic medical center for the treatment of real-world patients suffering with depression OBJECTIVES To assess the effectiveness of a self-management program for age-related macular degeneration ( AMD ) in reducing depressive symptoms . DESIGN Analysis of 6-month follow-up for a subset of participants in a r and omized , controlled trial who were clinical ly depressed at baseline . SETTING University ophthalmology clinic . PARTICIPANTS Thirty-two depressed older adult volunteers ( mean age 81.5 ) with advanced AMD who had been r and omized to a self-management program ( n=12 ) or one of two control conditions ( n=20 ) . Subjects were included if at baseline they met criteria from the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders , Axis , I , Fourth Edition , Research Version , for major or minor depressive disorder with significant depressive symptoms ( > or=5 points ) on the 15-item Geriatric Depression Scale ( GDS-15 ) . INTERVENTION AMD self-management program consisting of cognitive and behavioral elements including health education and enhancement of problem-solving skills . MEASUREMENTS Primary outcome measure was GDS-15 . Secondary outcome measures included National Eye Institute Visual Function Question naire ( NEI-VFQ ) and AMD Self-Efficacy Question naire . RESULTS At 6-month follow-up , the self-management group had a significantly greater reduction in depressive symptoms on the GDS-15 than the controls ( P=.03 ) . The mean reduction of 2.92 points in the self-management group was more than the 2-point change threshold considered to be clinical ly meaningful . Change on the NEI-VFQ was nonsignificant . Reduction in depressive symptoms was associated with greater self-efficacy in the self-management group . CONCLUSION These findings may support the effectiveness of an AMD self-management program for depressed older adults with advanced vision loss from AMD OBJECTIVES Age-related macular degeneration ( AMD ) is a common , disabling disorder of older age that is associated with depression . We investigated the incidence rate of depression and its risk factors and consequences in this 6-month longitudinal study . DESIGN A prospect i ve cohort study in which subjects were interviewed 6 weeks after the onset of bilateral vision loss and 6 months later . SETTING The sample was recruited from the retinovascular clinic of a specialty eye hospital . PARTICIPANTS Subjects were 51 patients with new onset bilateral AMD . MEASUREMENTS We assessed depressive symptoms , personality traits , visual acuity , and vision and physical functioning . Additionally , we interviewed informants to obtain independent assessment s of subjects ' personality traits . RESULTS The baseline prevalence rate of syndromal depression was 23.5 % and high levels of depressive symptoms persisted over time . The 6-month incidence rate of depression was 27.8 % . The strongest risk factors for incident depression were self-rated and informant-rated neuroticism . Patients who developed syndromal depression were 8.3 times ( 95 % confidence interval = 1.1 - 63.4 ) more likely than nondepressed patients to become disabled in vision function , independent of change in visual acuity . CONCLUSION AMD is associated with high rates of depression and visual disability independent of severity of vision loss . The personality trait of neuroticism is highly predictive of incident depression and identifies patients at high risk for excess disability . Psychotherapeutic treatments targeted to this group may prevent depression and reduce disability PURPOSE To investigate the association between visual impairment and depression and anxiety in older people in Britain . DESIGN Population -based cross-sectional study . PARTICIPANTS Thirteen thous and nine hundred people aged 75 years and older in 49 family practice s in Britain . METHODS Vision was measured in 13 900 people aged 75 years and older in 49 family practice s taking part in a r and omized trial of health screening that included depression ( Geriatric Depression Scale [ GDS-15 ] ) and anxiety  ( General Health Question naire [ GHQ-28 ] ) . Cause of visual impairment ( binocular acuity less than 6/18 ) was assessed from medical records . Analysis was by logistic regression ( odds ratio [ OR ] and 95 % confidence interval [ CI ] ) , taking account of potential health and social confounders . MAIN OUTCOME MEASURES Levels of depression and anxiety . RESULTS Visually impaired people had a higher prevalence of depression compared with people with good vision . Of visually impaired older people , 13.5 % were depressed ( GDS-15 score of 6 or more ) compared with 4.6 % of people with good vision ( age- and gender-adjusted OR , 2.69 ; 95 % CI , 2.03 - 3.56 ) . Controlling for potential confounding factors , particularly activities of daily living , markedly attenuated the association between visual impairment and depression ( OR , 1.26 ; 95 % CI , 0.94 - 1.70 ) . There was little evidence for any association between visual impairment and anxiety . On the GHQ-28 scale , 9.3 % of visually impaired people had 2 or more symptoms of anxiety compared with 7.4 % of people with good vision . CONCLUSIONS Although cause and effect can not be established in a cross-sectional study , it is plausible that people with visual impairment are more likely to experience problems with functioning , which in turn leads to depression & NA ; Studies of the psychosocial aspects of visual impairment have emphasized the effects of blindness , giving relatively little attention to the effects of mild or partial visual impairment . Consequently , we know little about when in the course of visual loss significant psychosocial dysfunction develops . To address this question , we assessed psychosocial functioning at three times over eight months in 31 adults with proliferative diabetic retinopathy and mild to moderate visual impairment in at least one eye . Examination of the correlations between visual and psychosocial measures revealed strong and significant correlations between visual acuity and adjustment ( range of r = ‐0.45 to ‐0.68 ) , between visual acuity and psychological symptoms ( range of r = ‐0.39 to ‐0.50 ) , and between visual acuity and emotion‐focused coping ( range of r = ‐0.38 to ‐0.53 ) . The strength of these correlations and their occurrence in three independent measures of psychosocial functioning suggest a clinical ly meaningful relationship between visual and psychosocial functioning in the range of mild to moderate visual impairment . Psychosocial dysfunction related to visual impairment develops long before blindness . Further prospect i ve research on the psychosocial aspects of partial visual impairment will clarify this relationship and may help justify early intervention with rehabilitation in the visually impaired who do not qualify for services for the blind PURPOSE In addition to performance-based measures , vision-related quality of life ( QOL ) and other subjective measures of psychosocial functioning are considered important outcomes of training in the visually impaired . In a multicenter , masked , r and omized controlled trial , subjective effects of training in the use of closed-circuit televisions ( CCTV ) were investigated . METHODS Patients ( n = 122 ) were r and omized either to a treatment group that received usual delivery instructions from the supplier combined with concise outpatient training , or to a control group that received delivery instructions only . Subjective outcomes were the low vision quality -of-life question naire ( LVQOL ) , EuroQOL 5 dimensions , adaptation to age-related vision loss ( AVL ) , and the Center of Epidemiologic Studies Depression scales . Linear mixed models were used to investigate treatment effects . Differential effects of patient characteristics were studied by implementing higher order interactions into the models . RESULTS From baseline to follow-up , all patients perceived significantly less problems on the reading and fine work dimension ( -28.8 points ; P < 0.001 ) and the 
    Output:
    