Mental Health-related Disability Research Articles

Psychotherapy duration and work disability: A prospective Finnish register study.

The influence of psychotherapy duration on common mental disorder (CMD) outcomes remains a topic of ongoing debate. Whereas most research has focused on CMD symptom change, the evidence on the psychotherapy duration of subsequent CMD-related work disability and the change in psychotropic drug purchases is scarce. We used a register-based cohort representing 33% of the Finnish population. The participants included working-age individuals (N = 12,047, 76% women, mean age = 36) who initiated long-term psychotherapy, between 2014 and 2017. They were followed from 2011 to 2021 and psychotherapy duration ranged from less than a year to over 3 years. We used an interrupted time series design to analyze the psychotherapy duration-dependent changes in CMD-related work disability (primary outcome, operationalized as depression or anxiety-related sickness absence, SA, days) and the annual number of psychotropic drug purchases or distinct drugs purchased (secondary outcomes). There were no differences in the levels of work disability or drug purchases before the psychotherapy. We observed a decreasing level and trend in all outcomes across all psychotherapy duration groups. The largest decline in level was observed in the <1-year duration group (88% decline for SA and 43%-44% for drug purchases) while the smallest decline was in the 3+ years duration group (73% for SA and 27% for drug purchases). Work disability outcomes and duration varied among individuals, even with similar initial mental health-related work disability or use of auxiliary psychotropic treatments. Compared to longer psychotherapy, shorter psychotherapy was associated with sharper improvements.

The association of sociodemographic characteristics with work disability trajectories during and following long-term psychotherapy: a longitudinal register study

PurposeThis register-based study examined the trajectories of depression or anxiety disorder-related work disability during and following long-term psychotherapy and identified sociodemographic factors that indicate membership in different trajectory groups.MethodsData were drawn from national registers (Statistics Finland, Social Insurance Institution of Finland). Participants included a random sample of Finnish working-age individuals (18–55 years) who started psychotherapy treatment between 2011 and 2014 and were followed for 5 years: 1 year before and 4 years after the onset of psychotherapy (N = 3 605 individuals; 18 025 person-observations across five time points). Group-based trajectory modeling was applied to assign individuals to work disability trajectories by the number of annual mental health-related work disability months. Multinomial logistic regression was used to examine the associations between trajectory group membership and baseline sociodemographic factors of age, gender, occupational status, and geographical area of residence.ResultsFour mental health-related work disability trajectories were identified: stable very low (72%), decrease (11%), persistent low (9%) and persistent high (7%). Those with older age, female gender, lower occupational status, and living in sparsely populated geographical areas were more likely to belong to the most unfavorable trajectory group of persistent high work disability. The presence of multiple risk characteristics substantially increased the probability of belonging to the most adverse trajectory group.ConclusionsSociodemographic factors were associated with the course of mental health-related work disability in association with psychotherapy. Rehabilitative psychotherapy does not function as an equal support resource for work ability in all parts of the population.

Psychotherapy and change in mental health-related work disability - A prospective population level register-based study in Finland

Abstract Introduction Mental disorders are a major cause of work disability among working age population. Psychotherapy has been shown to be an effective treatment for mental disorders, but the evidence mainly comes from small scale randomised trials with a relatively short follow-up. Objectives We used population-based register data to examine the association between statutory rehabilitative psychotherapy and change in depression or anxiety related work disability using a quasi-experimental interrupted time series analysis. Methods All those who started rehabilitative psychotherapy in 2011-2014 comprised the study group. The study group included 10436 participants who were followed from three years prior to four years after the onset of rehabilitative psychotherapy, resulting in 83488 observations. Annual total number of mental health related work disability months was calculated based on total number of annual compensated sickness absence and disability pension days. Results The onset of rehabilitative psychotherapy marked a decline in depression or anxiety related work disability as compared to the counterfactual trend. Specifically, a 20% decrease in the level (incidence rate ratio, IRR 0.80; 95% CI 0.76-0.85) as well as a 48% decrease in the slope (IRR 0.52; 95% CI 0.50-0.54) of work disability was detected. The decline was steepest in the oldest age-group Conclusions Providing statutory psychotherapy may decrease work disability at the population level. Further evidence for causal inference and the potential heterogeneity of the association is required.

Employment trajectories and mental health-related disability in Belgium

ObjectivesAn individual’s quality of employment over time has been highlighted as a potential determinant of mental health. With mental ill-health greatly contributing to work incapacities and disabilities in Belgium, the present study aims to explore whether mental health, as indicated by registered mental health-related disability, is structured along the lines of employment quality, whereby employment quality is assessed over time as part of individuals’ labour market trajectories.MethodsUsing administrative data from the Belgian Crossroads Bank for Social Security over 16 quarters between 2006 and 2009, transitions between waged jobs of varying quality (based on dimensions of income, working time, employment stability and multiple jobholding), self-employment, and unemployment are considered among individuals in the labour force aged 30–40 at baseline (n = 41,065 women and 45,667 men). With Multichannel Sequence Analysis and clustering, we constructed ideal types of employment trajectories. Fitting Cox regressions, we then evaluated individuals’ hazard of experiencing a disability from a mental disorder between 2010 and 2016.ResultsOur analysis highlights various gender-specific trajectories. Among both genders, individuals exposed to near-constant unemployment over the initial 4 years showed the highest hazard of subsequent mental health-related disability compared to a group characterised by stable full-time employment, single jobholding, and above-median income. Trajectories involving a higher probability of subsidised and non-standard employment and (potential) spells of unemployment and lower relative income were also strong predictors of cause-specific disabilities. Health selection and confounding might, however, be contributing factors.ConclusionsOur study shows a gradient of mental disorders resulting in a disability along trajectory types. Our findings highlight the predictive power of labour market trajectories and their employment quality for subsequent mental disorder-related disability. Future research should examine the mechanisms, including selection effects in this association.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

BackgroundMental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based...

Mental Health and Disability Law in Nigeria: A Call for Affirmative Interpretation

Nigeria is the most populous African country, with an estimated population of over 200 million people, with about 20% to 30% of the population experiencing mental health disorder (MHD). Mental disorders have been associated with significant disability. Nigeria’s first mental health regulation came into force in 1916, and it was christened the Lunacy Ordinance.The use of the word, lunacy is not only discriminatory and derogatory; it also falls short of the World Health Organization’s definition of MHDs, violates the rights of persons living with mental disabilities, and discourages their inclusion into the society. Furthermore, since its enactment in 1958, the Lunacy law is yet to be amended, hence its failure to keep pace with modern mental health challenges, and realities. Unfortunately, mental health disabilities are not conspicuously addressed in the current disability law, the Discrimination against Persons with Disabilities (Prohibition) Act 2018, which appears heavily slanted towards physical disabilities based on the tone of its specific provisions.The crux of this paper is that the legislative intention of bringing mental health-related disability under the general rubric of disability should be given affirmative action in terms of interpretation of the terms of the law and the implementation thereof. The extreme focus of the law on physical disability, being the more obvious variety of functional limitation, will serve to impose double jeopardy on the mentally-ill if their equally disabling state of health is subordinated to physical disability. Therefore, we advocate equivalence of focus in terms of both physical and mental disabilities. Keywords: Mental health, Disability law, Nigeria, Affirmative interpretation DOI: 10.7176/JLPG/124-04 Publication date: September 30 th 2022

Twenty Years Into the 21st Century – Tech-related Accommodations for College Students with Mental Health and Other Disabilities

Virtually all North American two- and four-year colleges provide accommodations to their increasing numbers of students with disabilities. To explore technology and non-technology related accommodations for these students we surveyed 118 Canadian two- and four-year college students who self-reported at least one disability, including a mental health related disability, and indicated that they had registered for access services from their college. Seventy-four students without disabilities were included in some analyses. Our findings reveal emerging issues such as non-binary gender and multiple comorbidities, in addition to more targeted recommendations concerning technology use. For example, over half of our sample self-reported multiple disabilities; there is a large number of students with mental health related disabilities (e.g., anxiety disorders, mood disorders), many of whom have comorbid disabilities; binary (male, female) gender designations are outdated; and exam and classroom accommodations without technologies are still the most popular. Grades of students with and without disabilities did not differ. Similarly, the number of different types of accommodations in two- and four-year colleges did not differ. Students generally had high technology related self-efficacy and they saw the substantial benefit of technologies, especially of writing tools. Students with mental health related disability used somewhat fewer technologies for reading, writing and time management. Self-efficacy and perceived benefit were highest for writing technologies. General use technologies such as Microsoft Office and Google Docs that were reported by most students in this study are increasingly used as adaptive aids. In future, use of technology related accommodations is likely to include showing students how to use general use software.

A randomized factorial trial of internet-delivered cognitive behavioural therapy: An 8-week program with or without extended support and booster lesson

While internet-delivered cognitive behavioural therapy (ICBT) is effective, some patients suggest extended support post-treatment could improve care. In this randomized factorial trial, we examined the benefits of an 8-week therapist-assisted ICBT program offered with or without an optional 4-week extension of support (Factor 1) and with or without an optional booster lesson (Factor 2). Patients screened for ICBT for depression and/or anxiety were randomly assigned to the conditions (N = 434) and we examined the use of the extension and booster, differences between those who did or did not use extension or booster, and the impact of the extension or booster on outcomes, engagement, and satisfaction at 26-weeks post-enrollment. Therapists recorded time and observations with offering support during the extension and booster. In the extension group, 54.4% (n = 56) requested the extension, while in the booster group 50.9% (n = 56) accessed the booster, and in the combined group, 41.6% (n = 47) requested the extension and 51.3% (n = 58) accessed the booster. Those who requested the extension were older, and more likely to report medication and mental health service use and severe mental health-related disability at pre-treatment; they also reported putting less effort into ICBT and finding skills more difficult. The booster was more often used among those with lower symptom severity, and those who put more effort into and had more positive experiences with ICBT. As expected, those assigned to extension sent more messages to their therapist, and those assigned to booster logged in more often. Therapists also took more time to deliver ICBT with an extension (>18 min) or booster (>13 min) compared to the 8-week program, and perceived extension and booster as beneficial for some, but not all patients. Treatment satisfaction was high across conditions, and effect sizes were large from pre-treatment to 26-week follow-up on most measures. No significant group differences were found in this study. Lack of group differences, however, could reflect low use of the extension and booster. Results provide helpful information about the demand for extensions and boosters, and provide directions for future research.

Pharmacogenomics Guided Prescription Changes Improved Medication Effectiveness in Patients With Mental Health-Related Disability: A Retrospective Cohort Analyses.

Mental health problems are the leading cause of disability in Canadian workers. Medication ineffectiveness is hypothesized to increase the time to return-to-work in these workers. We assessed whether prescription changes based on pharmacogenomics profiling ( Report®) improved medication effectiveness in patients on mental health-related disability. In this retrospective cohort analyses, we assessed the impact of pharmacogenomic profiling on patient outcomes in 84 Canadian workers who were on a mental health-related disability between May 2018 and May 2019. All patients completed an informed consent form and a standard questionnaire including medical history, medications, disease symptoms, and medication side effects. Licensed pharmacists made recommendations for prescription changes in 83 patients. The main study outcome was medication effectiveness defined on a scale of 0 to 10 (0 being most effective and 10 being most ineffective) based on reported mood toward regular work tasks and medication side effects. We compared the medication effectiveness at baseline and at 3 months after the pharmacogenomics-based prescription changes. This retrospective cohort analyses included 46 patients who completed the follow-up questionnaires. Of them, 54% (n = 25) were females, 67% (n = 31) were Caucasians, and the mean age was 38 years (standard deviation [SD] = 11). The average baseline effectiveness score was 8.39 (SD =1.22). Following the prescription changes, the medication effectiveness scores significantly improved to an average of 2.30 (SD = 1.01) at 3 months of follow-up (effect size r = 0.62, p = <0.001). Pharmacogenomics could help in improving treatment outcomes in patients on mental health-related disability.

Disability Assessment in Geriatric Psychiatry and Social Welfare Measures in Geropsychiatry in India.

Background:Rising population of elder people and associated rise in health problems, frailty and disabilities have significant socioeconomic and health care implications. Mental health related disability contributes significantly in the global disability statistics and is an important health and quality of life indicator. Assessment of disabilities in elderly is essential part of routine evaluation, further it also helps the clinicians in identifying current functional status and choosing and monitoring therapeutic interventions and need for social welfare schemes.Methods:In order to understand the process of disability assessment in geriatric psychiatry and to gather information about social welfare schemes a literature review in Google Scholar and PubMed electronic database, and website of various ministries under Government of India was done, using developed key search terms for articles published up to February 2021. The identified eligible articles were reviewed for ideas and concepts, which were then integrated and categorized under broader themes. Finally, the broad categories were discussed briefly based on the above framework.Results:Review findings are summarized under the following headings: concept of ageing and disability, assessment of disability, process of certification, and social welfare schemes.Conclusions:The process of disability assessment comprises of comprehensive clinical evaluation, use of standardized rating instruments and disability certification wherever warranted or asked for. It is now being acknowledged worldwide by provisions of various social welfare benefits, that living with disability and increased care needs should be an integral part of definition of successful ageing.

Opioid use in pregnant women with mental health-related disabilities

The purpose of this study was to examine associations between opioid use and the degree of mental health-related disability due to emotional/behavioral problems as measured by the World Health Organization Disability Assessment Schedule (WHODAS) instrument in a national sample of pregnant women. We used data from the National Survey on Drug Use and Health 2014-2017 which included 2,888 pregnant women 18years or older. The WHODAS instrument was utilized to measure disability as the degree of functional impairment due to emotional/behavioral problems experienced by the respondent. Multinomial logistic regression models were built to assess the magnitude and direction of the association between severity of mental health-related disability with opioid use and abuse/dependency in the past year. Approximately 30% of pregnant women suffered from moderate/severe mental health-related disability, and 2% reported opioid abuse/dependency. Compared to those with no opioid use, the odds of opioid use in the past year for individuals with moderate/severe mental health-related disability were 1.73 (95% CI 1.36, 2.21) times higher than those with no/mild disability. Similarly, the odds of opioid abuse/dependency were at least three times higher (OR 3.51; 95% CI 1.80, 6.84) among those with moderate/severe mental health-related disability relative to pregnant women with no/mild disability. Clinicians should consider screening for both opioid use and mental health conditions and related disabilities using screening tools such as the WHODAS during the initial prenatal visits.

Disability and severe depression among Peruvian older adults: analysis of the Peru Demographic and Family Health Survey, ENDES 2017

BackgroundDepression is considered a mental health-related disability that affects approximately 350 million people worldwide. On the other hand, it is estimated that 15% of the world’s population lives with some form of disability, and this scenario is currently riddled with the global burden of mental disorders, non-communicable diseases and other age-related comorbidities.AimTo assess the association between disability and depression among Peruvian older adults.MethodsWe used data from the 2017 Peru Demographic and Familiar Health Survey, with a focus on adults aged 50 years and older. Whereas the presence of disability was assessed using different questions of the survey, depression was measured with the Patient Health Questionnaire-9 (PHQ-9). We calculated the adjusted prevalence ratios (aPR) using Poisson regression models with log link function, with their respective 95% confidence intervals (95% CI).ResultsFrom the study population, 5% had a disability. In addition, 43.3% were screened positive for depression (13.2% for moderately severe/severe). After adjusting for confounding variables, disability was associated with moderate and severe depression (aPR: 1.06; 95% CI: 1.01–1.11, aPR: 1.10; 95% CI: 1.05–1.15).ConclusionDisability was positively associated with moderate and severe depression. Public health policies should address the early diagnosis and rehabilitation of patients with any of these problems. Likewise, coping strategies should be promoted among families of persons with disabilities.

Examining the cognitive and mental health related disability rates among the homeless: Policy implications of changing the definition of disability in Ontario.

Examining the cognitive and mental health related disability rates among the homeless: Policy implications of changing the definition of disability in Ontario.

Marijuana Use among Pregnant Women with Mental Health-Related Disabilities

This study was designed to examine prenatal marijuana use in pregnant women with disabilities related to mental health. Almost one-third (28.8%) of 3805 pregnant women reported a mental health-related disability, and 4% reported past 30-day marijuana use. Women with a moderate/severe mental health-related disability had higher adjusted-odds of marijuana use (OR: 2.05, 95% CI: 1.33, 3.16) than did their counterparts. Women were significantly more likely to use marijuana in the first than in a later trimester. Given potential adverse health outcomes associated with prenatal marijuana use, providers should screen pregnant women with mental health-related disabilities for marijuana use, and intervene to prevent and reduce/eliminate use.

The importance of clinical and labour market histories in psychiatric disability retirement: analysis of the comprehensive Finnish national-level RETIRE data

ObjectivesDespite the stable incidence of mental disorders in Finland and Europe, mental health-related occupational disability has been increasing. We unveiled the paths to permanent psychiatric disability, recovery, or death, by analysing sequences of labour market participation.MethodsThe RETIRE register database includes information regarding all persons (n = 42,170) awarded an ICD-10 psychiatric disability pension between 2010 and 2015 in Finland. We identified clusters of typical paths of pre-retirement labour market history. Controlling for major mental disorders, age, and sex, we evaluated factors associated with returning to work (RTW), or death, over a 5-year follow-up period.ResultsOnly 10.5% of the disabled subjects returned to work within the follow-up. Half of them ended up with a permanent disability pension. Seven distinguishable paths to disability were identified. Subjects in the cluster characterized by steady employment were relatively often females, lost their work ability due to affective disorders, and had the highest rate of returning to work (16.3%). Mortality was highest (9%) among the cluster characterized by long-term unemployment. Distributions of major diagnostic groups, as well as age and sex, differed between clusters. After their adjustment in the analysis of RTW or death, the identified labour market history paths prior to losing work ability remained as important independent prognostic factors for both outcomes.ConclusionsThe complex retirement process involves identifiable clinical and contextual associating factors. Labour market history patterns associate with varying prognoses after psychiatric retirement. Prolonged unemployment appears as a predictor of relatively poor prognoses, whereas employment indicates the opposite.

Relationships Among Race/Ethnicity, Gender, and Mental Health Status in Patient–Provider Interactions

Patient–provider interactions are associated with improved health outcomes and are of particular importance to individuals with mental health disabilities. We examine the relation between having a severe mental health–related disability (SMD) and patient–provider interactions and whether this is moderated by patient race/ethnicity and gender. We pooled Medical Expenditure Panel Survey data over multiple years and used multivariate techniques to examine the relation between having a SMD, race/ethnicity and gender and four measures of patient/provider interactions (e.g., being treated with respect). Adults with SMD had significantly higher relative risks (RRs) of reporting poorer interactions across measures. Although some effects of race/ethnicity and gender were observed, they did not moderate SMD. Individuals with Medicaid coverage or no health insurance had higher RRs of poorer interactions, while individuals with a person as a usual source of care had lower RRs. Incorporating these process measures of care into national quality initiatives may foster improved interactions. Continued policy support of models of care such as medical homes may enhance interactions as well.

PROTOCOL: Voluntary work for the physical and mental health of older volunteers.

PROTOCOL: Voluntary work for the physical and mental health of older volunteers.

The generational gap: Mental disorder prevalence and disability amongst first and second generation immigrants in Australia

Despite unprecedented numbers of migrants internationally, little is known about the mental health needs of immigrant groups residing in common countries of resettlement. The majority of studies support the ‘healthy migrant hypothesis’, but few studies have examined: 1) shifts in prevalence patterns across generations; 2) how prevalence relates to disability in immigrant groups. Our study examined the prevalence of common mental disorders and disability in first and second generation migrants to Australia. Twelve-month and lifetime prevalence rates of affective, anxiety, and substance use disorders were obtained from the Australian National Survey of Mental Health and Wellbeing (N = 8841). First generation immigrants (born overseas) and second generation immigrants (both parents overseas) from non-English and English speaking backgrounds were compared to an Australian-born cohort. Disability was indexed by days out of role and the WHO Disability Assessment Schedule (WHODAS12). First generation immigrants with non-English speaking (1G-NE) backgrounds evidenced reduced prevalence of common mental disorders relative to the Australian-born population (adjusted odds ratio 0.5 [95% CI 0.38–0.66]). This lower prevalence was not observed in second generation immigrant cohorts. While overall levels of disability were equal between all groups (p > 0.05), mental health-related disability was elevated in the 1G-NE group relative to the Australian-born group (p = 0.012). The findings challenge the overarching notion of the “healthy migrant” and suggest a dissociation between reduced prevalence and elevated mental health-related disability amongst first generation immigrants with non-English speaking backgrounds. These findings highlight the heterogeneous psychiatric needs of first and second generation immigrants.

Dualising activation. Responses to unemployment and mental health-related disability retirement in Finland at the turn of the millennium

ABSTRACT‘Activation’, referring to measures that increase the labour supply, has recently been a key concept in discussing employment in the developed countries. This paper analyses the motivations behind activation measures targeted at the unemployed as well as persons disabled due to mental health problems, as expressed through legislation and national policy documents following the 1990s recession in Finland. The analysis points out that the activation measures implemented in Finland at the turn of the millennium have had a tendency to reinforce ‘dualisation’, that is, to polarise citizens as either labour market insiders or outsiders. The analysis shows that activation also involves labels that fix blame on the people themselves for their situation. Hence, the activation measures have increased the risk of exclusion for many of the persons they were supposed to help. The results are discussed in the context of the broader literature on the Nordic welfare and labour market model.

Media-delivered cognitive behavioural therapy and behavioural therapy (self-help) for anxiety disorders in adults

Anxiety disorders are the most common mental health problems. They are chronic and unremitting.Effective treatments are available, but access to services is limited.Media-delivered behavioural and cognitive behavioural interventions (self-help) aim to deliver treatment with less input from professionals compared with traditional therapies. To assess the effects of media-delivered behavioural and cognitive behavioural therapies for anxiety disorders in adults. Published and unpublished studies were considered without restriction by language or date. The Cochrane Depression, Anxiety and Neurosis Review Group's Specialized Register (CCDANCTR) was searched all years to 1 January 2013. The CCDANCTR includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). Complementary searches were carried out on Ovid MEDLINE (1950 to 23 February 2013) and PsycINFO (1987 to February, Week 2, 2013), together with International trial registries (the trials portal of the World Health Organization (ICTRP) and ClinicalTrials.gov). Reference lists from previous meta-analyses and reports of randomised controlled trials were checked, and authors were contacted for unpublished data. Randomised controlled trials of media-delivered behavioural or cognitive behavioural therapy in adults with anxiety disorders (other than post-traumatic stress disorder) compared with no intervention (including attention/relaxation controls) or compared with face-to-face therapy. Both review authors independently screened titles and abstracts.Study characteristics and outcomes were extracted in duplicate. Outcomes were combined using random-effects models, and tests for heterogeneity and for small study bias were conducted.We examined subgroup differences by type of disorder, type of intervention provided, type of media, and recruitment methods used. One hundred and one studies with 8403 participants were included; 92 studies were included in the quantitative synthesis. These trials compared several types of media-delivered interventions (with varying levels of support) with no treatment and with face-to-face interventions. Inconsistency and risk of bias reduced our confidence in the overall results. For the primary outcome of symptoms of anxiety, moderate-quality evidence showed medium effects compared with no intervention (standardised mean difference (SMD) 0.67, 95% confidence interval (CI) 0.55 to 0.80; 72 studies, 4537 participants), and low-quality evidence of small effects favoured face-to-face therapy (SMD -0.23, 95% CI -0.36 to -0.09; 24 studies, 1360 participants). The intervention was associated with greater response than was seen with no treatment (risk ratio (RR) 2.34, 95% CI 1.81 to 3.03; 21 studies, 1547 participants) and was not significantly inferior to face-to-face therapy in these studies (RR 0.78, 95 % CI 0.56 to 1.09; 10 studies, 575 participants), but the latter comparison included versions of therapies that were not as comprehensive as those provided in routine clinical practice. Evidence suggested benefit for secondary outcome measures (depression, mental-health related disability, quality of life and dropout), but this evidence was of low to moderate quality. Evidence regarding harm was lacking. Self-help may be useful for people who are not able or are not willing to use other services for people with anxiety disorders; for people who can access it, face-to-face cognitive behavioural therapy is probably clinically superior. Economic analyses were beyond the scope of this review.Important heterogeneity was noted across trials. Recent interventions for specific problems that incorporate clinician support may be more effective than transdiagnostic interventions (i.e. interventions for multiple disorders) provided with no guidance, but these issues are confounded in the available trials.Although many small trials have been conducted, the generalisability of their findings is limited.Most interventions tested are not available to consumers.Self-help has been recommended as the first step in the treatment of some anxiety disorders, but the short-term and long-term effectiveness of media-delivered interventions has not been established.Large, pragmatic trials are needed to evaluate and to maximise the benefits of self-help interventions.