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.

FTM transgender participants reported significantly reduced mental health-related quality of life and require additional focus to determine the cause of this distress. Providing this community with the hormonal care they request is associated with improved quality of life.

Objective To quantify the association between stressful life events and exacerbations of multiple sclerosis. Data sources PubMed, PsychInfo, and Psychological Abstracts searched for empirical papers from 1965 to February 2003 with terms "stress", "trauma", and "multiple sclerosis". Review methods Three investigators independently reviewed papers for inclusion/exclusion criteria and extracted the relevant data, including methods, sample statistics, and outcomes. Results Of 20 studies identified, 14 were included. The meta-analysis showed a significant increase in risk of exacerbation in multiple sclerosis after stressful life events, with a weighted average effect size of d = 0.53 (95% confidence interval 0.40 to 0.65), P < 0.0001. The studies were homogenous, Q = 16.62, P = 0.22, I 2 = 21.8%. Neither sampling nor study methods had any effect on study outcomes. Conclusions There is a consistent association between stressful life events and subsequent exacerbation in multiple sclerosis. However these data do not allow the linking of specific stressors to exacerbations nor should they be used to infer that patients are responsible for their exacerbations. Investigation of the psychological, neuroendocrine, and immune mediators of stressful life events on exacerbation may lead to new behavioural and pharmacological strategies targeting potential links between stress and exacerbation.

The majority of primary care patients surveyed reported one or more perceived barriers that would interfere with or prevent initiation or regular attendance of psychotherapy. Perceived barriers were more common among depressed than nondepressed patients making depression both an indicator for psychotherapy and a barrier to receiving it.

Increasingly, the telephone is being used to deliver psychotherapy for depression, in part as a means to reduce barriers to treatment. Twelve trials of telephone-administered psychotherapies, in which depressive symptoms were assessed, were included. There was a significant reduction in depressive symptoms for patients enrolled in telephone-administered psychotherapy as compared to control conditions (d = 0.26, 95% confidence interval [CI] = 0.14-0.39, p < .0001). There was also a significant reduction in depressive symptoms in analyses of pretreatment to posttreatment change (d = 0.81, 95% CI = 0.50-1.13, p < .0001). The mean attrition rate was 7.56% (95% CI = 4.23-10.90). These findings suggest that telephone-administered psychotherapy can produce significant reductions in depressive symptoms. Attrition rates were considerably lower than rates reported in face-to-face psychotherapy. Keywords depression; meta-analysis; psychotherapy; telemental healthThe telephone was invented by Alexander Graham Bell in 1876. The first report of telemedicine in a major medical journal, which described the use of the telephone to diagnose a child's cough, occurred three years later in 1879 ("The Telephone as a Medium of Consultation and Medical Diagnosis," 1879). The telephone quickly became a widely used tool in the practice of primary-care medicine. In contrast, providers of psychotherapy were slow to adopt the telephone to deliver mental health-related services. To the best of our knowledge, the first report of the use of the telephone in the administration of psychotherapy was published in 1949, 70 years after the first telemedicine report (Berger & Glueck, 1949). In 1996, a report developed by an American Psychological Association task force found that empirical evidence concerning telephone-administered psychotherapy was (Haas, Benedict, & Kobos, 1996). In the last decade, this has changed considerably.Most of the work in telephone-administered psychotherapy has focused on treating depressive symptoms. Depression is common and is a significant cause of disability (Murray & Lopez, 1997). Psychotherapy is an attractive treatment option for many patients, as evidenced by the finding that approximately two-thirds of depressed patients prefer psychotherapy over antidepressant medication (Bedi et al., 2000;Brody Khaliq, & Thompson, 1997;Dwight-Johnson, Sherbourne, Liao, & Wells, 2000;Priest, Vize, Roberts, Roberts, & Tylee, 1996). However, only 20% of all patients referred for psychotherapy ever enter treatment (Brody et al., 1997;Weddington, 1983) and, of those who enter, nearly onehalf will drop out (Wierzbicki & Pekarik, 1993). One reason for this discrepancy between interest and failure to initiate or follow through with psychotherapy is that there are considerable barriers for many patients, including time constraints, transportation problems, caregiving responsibilities, stigma concerns, disability, or living in a rural area that lacks adequate mental health services (Alvidrez & Azocar, 1999;Hollon et al., 2002;Y...

Rather than being based only on clinical presentation and disease progression, decisions about treatment receipt for some men are influenced by cancer related anxiety. Men should be provided with more psychosocial support to perhaps delay treatment and the ensuing decrements in health related quality of life.

These findings suggest that treatment for depression is associated with reductions in the severity of fatigue symptoms, and that this relationship is due primarily to treatment related changes in mood.

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