Meaning in life and flow experiences among people with psychiatric disabilities who are engaged in peer-helping vs. non-helping work-roles

Abstract

BACKGROUND:

Finding meaning in life and wellbeing through vocational work-roles are central to recovery of persons with psychiatric disabilities. However, there is a disconnect between positive concepts and vocational rehabilitation, rendering meaning and wellbeing rarely explored in vocational rehabilitation.

OBJECTIVE:

We assume higher meaning and wellbeing exists among individuals engaged in peer-helping work-roles (meaningful role) as compared to non-helping work-roles. We examine this and additional questions to learn about relationships between positive concepts and vocational work-roles illuminating mental health recovery.

METHODS:

114 individuals with psychiatric disabilities (ages 20-70) from various vocational-services participated. Sixty-nine worked in peer-helping roles (i.e. consumer-providers/peer-supporters) and 45 engaged in non-helping work-roles (vendors/clerical work, etc.). Participants filled in the meaning in life and work-related flow (assessing wellbeing at work) scales. Additionally, participants in peer-helping work-roles filled a peer-developed scale estimating their salience of peer-role characteristics.

RESULTS:

Individuals in peer-helping work-roles had significantly higher meaning in life levels than those in non-helping roles. Having meaning in life also predicted higher work-related flow across the sample. Finally, meaning in life positively mediated relations between salience of peer-role characteristics and work-related flow experiences.

CONCLUSION:

Researching meaning and wellbeing can broaden theoretical understanding and bear practical implications for enhancing vocational work-role fit mental health recovery.

Keywords

Mental health recovery psychiatric rehabilitation positive psychology occupational groups supported employment vocational work-roles peer providers generativity

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References

Akinola,

O. A.

, Doabler,

C. T.

(2022). Determinants of employment outcomes of transition-age youth with depressive disorders. Journal of Vocational Rehabilitation, 56, 55–68. https://doi.org/10.3233/JVR-211172

Allan,

B. A.

, Dexter,

, Kinsey,

, Parker,

(2018). Meaningful work and mental health: job satisfaction as a moderator. J Ment Health, 27(1), 38–44. https://doi.org/10.1080/09638237.2016.1244718.

An,

J. S.

, Cooney,

T. M.

(2006). Psychological well-being in mid to late life: The role of generativity development and parent-child relationships across the lifespan. International Journal of Behavioral Development, 30(5), 410–421. https://doi.org/10.1177/0165025406071489.

Andresen,

, Caputi,

, Oades,

L. G.

(2010). Do clinical outcome measures assess consumer-defined recovery?Psychiatry Res, 177(3), 309–317. https://doi.org/10.1016/j.psychres.2010.02.013.

Anthony,

W. A.

(1993). Recovery from mental illness: the guiding vision of the mental health service system in the 1990s. Psychosocial rehabilitation journal,, 16(4), 11.

Arnett,

J. J.

(2015). The Oxford handbook of emerging adulthood.

Auerbach,

E. S.

, Richardson,

(2005). The long-term work experiences of persons with severe and persistent mental illness. Psychiatr Rehabil J, 28(3), 267–273. https://doi.org/10.2975/28.2005.267.273.

Aviram,

, Ginath,

, Roe,

(2012). Mental health reforms in Europe: Israel’s rehabilitation in the community of persons with mental disabilities law: challenges and opportunities. Psychiatr Serv, 63(2), 110–112. https://doi.org/10.1176/appi.ps.201100009.

Bakker,

A. B.

(2008). The work-related flow inventory: Construction and initial validation of the WOLF. Journal of Vocational Behavior, 72(3), 400–414.

10.

Bakker,

A.B.

, Demerouti,

(2008). “Towards a model of workengagement”. Career Development International, 13(3), 209–223. https://doi.org/10.1108/13620430810870476.

11.

Becker,

, Drake,

R. E.

(2003). A working life for people with severe mental illness. Oxford Press.

12.

Bejerholm,

, Roe,

(2018). Personal recovery within positive psychiatry. Nord J Psychiatry, 72(6), 420–430. https://doi.org/10.1080/08039488.2018.1492015.

13.

Beveridge,

, Fabian,

(2007). Vocational Rehabilitation Outcomes: Relationship Between Individualized Plan for Employment Goals and Employment Outcomes. Rehabilitation Counseling Bulletin, 50(4), 238–246. doi:10.1177/00343552070500040501.

14.

Blank,

, Hayward,

(2009). The Role of Work in Recovery. British Journal of Occupational Therapy, 72(7), 324–326. https://doi.org/10.1177/030802260907200709.

15.

Bond,

G. R.

, Campbell,

, Becker,

D. R.

(2013). A test of the occupational matching hypothesis for rehabilitation clients with severe mental illness. J Occup Rehabil, 23(2), 261–269. https://doi.org/10.1007/s10926-012-9388-7.

16.

Bril-Barniv,

, Moran,

G. S.

, Naaman,

, Roe,

, Karnieli-Miller,

(2017). A Qualitative Study Examining Experiences and Dilemmas in Concealment and Disclosure of People Living With Serious Mental Illness. Qual Health Res, 27(4), 573–583. https://doi.org/10.1177/1049732316673581.

17.

Burke,

E. M.

, Pyle,

, Machin,

, Morrison,

A. P.

(2018). Providing mental health peer support 2: Relationships with empowerment, hope, recovery, quality of life and internalised stigma. Int J Soc Psychiatry, 64(8), 745–755. https://doi.org/10.1177/0020764018810307.

18.

Carmona,

V. R.

, Gómez-Benito,

, Rojo-Rodes,

J. E.

(2019). Employment Support Needs of People with Schizophrenia: A Scoping Study. J Occup Rehabil, 29(1), 1–10. https://doi.org/10.1007/s10926-018-9771-0.

19.

Chaudoir,

S. R.

, Quinn,

D. M.

(2010). Revealing concealable stigmatized identities: The impact of disclosure motivations and positive first disclosure experiences on fear of disclosure and well-being. J Soc Issues, 66(3), 570–584. https://doi.org/10.1111/j.1540-4560.2010.01663.x.

20.

Chow,

C. M.

, Cichocki,

, Croft,

(2014). The impact of job accommodations on employment outcomes among individuals with psychiatric disabilities. Psychiatr Serv, 65(9), 1126–1132. https://doi.org/10.1176/appi.ps.201300267.

21.

Cronise,

, Teixeira,

, Rogers,

E. S.

, Harrington,

(2016). The peer support workforce: Results of a national survey. Psychiatr Rehabil J, 39(3), 211–221. https://doi.org/10.1037/prj0000222.

22.

Csikszentmihalyi,

(1990). Flow: The psychology of optimal experience. HarperCollins.

23.

Csikszentmihalyi,

(2000). Beyond boredom and anxiety. CA: Jossey-Bass.

24.

Davidson,

, Bellamy,

, Guy,

, Miller,

(2012). Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry, 11(2), 123–128. https://doi.org/10.1016/j.wpsyc.2012.05.009.

25.

Davidson,

, Chinman,

, Kloos,

, Weingarten,

, Stayner,

, Tebes,

J. K.

(1999). Peer support among individuals with severe mental illness: A review of the evidence. Clinical psychology: Science and practice, 6(2), 165–187.

26.

Deci,

E. L.

, Ryan,

R. M.

(2000). The “what” and “why” of goal pursuits: Human needs and the self-determination of behavior. Psychological Inquiry, 11, 227–268.

27.

Deegan,

P. E.

(2002). Recovery as a Self-Directed Process of Healing and Transformation. Occupational Therapy in Mental Health,5–21. https://doi.org/10.1300/J004v17n03_02.

28.

Drake,

R. E.

, Hogan,

M. F.

, Slade,

, Thornicroft,

(2011). Editorial: Commentary on Israel’s Psychiatric Rehabilitation Law. Israeli Journal of Psychiatry and Related Sciences, 48(4), 227–229.

29.

Dunn,

E. C.

, Wewiorski,

N. J.

, Rogers,

E. S.

(2008). The meaning of employment to people in recovery. Psychiatric Rehabilitation Journal, 32(1), 59–62.

30.

Erikson,

E. H.

(1963). Youth: Change and challenge. Basic books.

31.

Fabian,

(2014). Work and disability. In D. E. In Blustein (Ed.), The Oxford handbook of psychology of working, pp. 185–200. Oxford University Press.

32.

Farkas,

, Anthony,

W. A.

(2010). Psychiatric rehabilitation interventions: a review. Int Rev Psychiatry, 22(2), 114–129. https://doi.org/10.3109/09540261003730372.

33.

Farkas,

, Gagne,

, Anthony,

, Chamberlin,

(2005). Implementing recovery oriented evidence based programs: identifying the critical dimensions. Community Mental Health Journal, 41(2), 141–158. https://doi.org/10.1007/s10597-005-2649-6.

34.

Geyser,

, Geldenhuys,

, Crous,

(2015). The dimensionality of the Work Related Flow Inventory (WOLF): a South African study. Journal of Psychology in Africa, 25(4), 282–287.

35.

Gillard,

, Foster,

, Turner,

(2016). Evaluating the Prosper peer-led peer support network: a participatory, coproduced evaluation. Mental Health and Social Inclusion, 20(2), 80–91.

36.

Hayes,

A. F.

(2013). Introduction to mediation, moderation, and conditional process analysis : a regression-based approach.

37.

Hornik-Lurie,

, Shalev,

, Haknazar,

, Garber Epstein,

, Ziedenberg-Rehav,

, Moran,

G. S.

(2018). Implementing recovery-oriented interventions with staff in a psychiatric hospital: A mixed-methods study. Journal of Psychiatric Mental Health Nursing, 25(9-10), 569–581. https://doi.org/10.1111/jpm.12502.

38.

Keyes,

C. L.

(2007). Promoting and protecting mental health as flourishing: a complementary strategy for improving national mental health. American Psycholgist, 62(2), 95–108. https://doi.org/10.1037/0003-066x.62.2.95.

39.

Killackey,

(2020). Vocational recovery in young people with mental health problems. In Progress and directions. In Youth Mental Health (pp. 181–194).

40.

Killackey,

, Jackson,

H. J.

, McGorry,

P. D.

(2008). Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. British Journal of Psychiatry, 193(2), 114–120. https://doi.org/10.1192/bjb107.043109.

41.

Klee,

, Chinman,

, Kearney,

(2019). Peer specialist services: New frontiers and new roles. Psychological Services, 16(3), 353–359. https://doi.org/10.1037/ser0000332.

42.

Kotre,

J. N.

(1984). Outliving the self: Generativity and the interpretation of lives. Johns Hopkins University Press.

43.

Kukla,

, Bond,

(2012). Job match and job tenure in personswith severe mental illness. Journal of Rehabilitation, 78, 11–15.

44.

Leamy,

, Bird,

, Le Boutillier,

, Williams,

, Slade,

(2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445–452. https://doi.org/10.1192/bjb110.083733.

45.

Linstone,

, Turoff,

(1975). The Delphi Method: Techniques and Applications (Vol. 18). https://doi.org/10.2307/3150755

46.

Lopez,

S. J.

, Snyder,

C. R.

, Nakamura,

, Csikszentmihalyi,

(2012). Flow Theory and Research. Oxford University Press.

47.

Luciano,

, Bond,

G. R.

, Drake,

R. E.

(2014). Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophrenia Research, 159(2-3), 312–321. https://doi.org/10.1016/j.schres.2014.09.010.

48.

McAdams,

D. P.

(2013). The redemptive self: stories Americans live by. Oxford. Oxford University Press.

49.

McDonald-Wilson,

K. L.

, Rogers,

E. S.

, Massaro,

(2003). Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities. Journal of Vocational Rehabilitation, 18(1), 15–24.

50.

Mahlke,

C. I.

, Krämer,

U. M.

, Becker,

, Bock,

(2014). Peer support in mental health services. Current Opinion in Psychiatry, 27(4), 276–281. https://doi.org/10.1097/yco.0000000000000074.

51.

Martin,

F. H.

, Walls,

R. T.

, Brodwin,

M. G.

, Parker,

R. M.

, Siu,

F. W.

, Kurata,

(2012). Competitive employment outcomes of vocational rehabilitation. Journal of Applied Rehabilitation Counseling,, 43, 3–10.

52.

McAdams,

D. P.

, St Aubin,

E. D.

, Logan,

R. L.

(1993). Generativity among young, midlife, and older adults. Psychology of Aging, 8(2), 221–230https://doi.org/10.1037//0882-7974.8.2.221.

53.

McMahon,

B. T.

, Kim,

J. H.

(2016). Foreword to Special Topic Section on the Interface of Positive Psychology with Rehabilitation Research and Practice. Journal of Occupational Rehabilitation, 26(1), 1–3. https://doi.org/10.1007/s10926-015-9621-2.

54.

McQuilken,

, Zahniser,

J. H.

, Novak,

, Starks,

R. D.

, Olmos,

, Bond,

G. R.

(2003). The work project survey: Consumer perspectives on work. Journal of Vocational Rehabilitation, 18(1), 59–68.

55.

Michaelson,

, Pratt,

M.G.

, Grant,

A.M.

et al. (2014). Meaningful Work: Connecting Business Ethics and Organization Studies. Journal of Business Ethics, 121, 77–90. https://doi.org/10.1007/s10551-013-1675-5.

56.

Millner,

U. C.

, Rogers,

E. S.

, Bloch,

, Costa,

, Pritchett,

, Woods,

(2015). Exploring the work lives of adults with serious mental illness from a vocational psychology perspective. Journal of Counselling Psychology, 62(4), 642–654. https://doi.org/10.1037/cou0000109.

57.

Millner,

U. C.

, Rogers,

E. S.

, Bloch,

, Costa,

, Pritchett,

, Woods,

, ... Hintz,

(2020). Unpacking the Meaning of Work for Individuals Living With Serious Mental Illness. Journal of Career Development, 49(2), 393–410. https://doi.org/10.1177/0894845320941256.

58.

Moran,

G. S.

(2018). A recovery-oriented peer provider (ROPP) work-role model and prototype measure. American Journal of Psychiatric Rehabilitation,, 20(4), 346–368.

59.

Moran,

G. S.

, Westman,

, Weissberg,

, Melamed,

(2017). Perceived assistance in pursuing personal goals and personal recovery among mental health residents across housing services. Psychiatry Research, 249, 94–101.

60.

Moran,

G. S.

, Russinova,

, Gidugu,

, Yim,

J. Y. S.

, Gagne,

(2013). Challenges experienced by paid peer providers in mentalhealth recovery: A qualitative study. Community Mental HealthJournal, 49(3), 281–291.

61.

Moran,

G. S.

, Russinova,

, Gidugu,

, Yim,

J. Y.

, Sprauge,

(2012). Benefits and mechanisms of peer providers with mentalillnesses. Qualitative Health Research, 22(3), 304–319.

62.

Moran,

G.S.

, Kalha,

, Mueller-Stierlin,

A.S.

, Kilian,

, Krumm,

, Slade,

, et al. (2020). Peer support for people with severe mental illness versus usual care in high-, middle- and low-income countries: study protocol for a pragmatic, multicentre, randomised controlled trial (UPSIDES-RCT. Trials, 21(1), 371.

63.

Mueser,

K. T.

, Cook,

J. A.

(2012). Supported employment, supported education, and career development. Psychiatr Rehabil J, 35(6), 417–420. https://doi.org/10.1037/h0094573.

64.

Onken,

S. J.

, Craig,

C. M.

, Ridgway,

, Ralph,

R. O.

, Cook,

J. A.

(2007). An analysis of the definitions and elements of recovery: a review of the literature. Psychiatr Rehabil J, 31(1), 9–22. https://doi.org/10.2975/31.1.2007.9.22.

65.

Pratt,

M. G.

, Ashforth,

B. E.

(2003). Fostering meaningfuness in working and at work. In K. Cameron, J. E. Dutton, & R. E. Quinn (Eds.), Positive organizational scholarship: Foundations of a new discipline (pp. 308–327). San Francisco: Berrett-Koehler.

66.

Peterson,

B. E.

(2002). Longitudinal analysis of midlife generativity, intergenerational roles, and caregiving. Psychol Aging, 17(1), 161.

67.

Repper,

, Carter,

(2011). A review of the literature on peer support in mental health services. J Ment Health, 20(4), 392–411. https://doi.org/10.3109/09638237.2011.583947.

68.

Riessman,

(1965). The “Helper” Therapy Principle. Social Work, 10(2), 27–32.

69.

Roe,

, Bril-Barniv,

, Kravetz,

(2012). Recovery in Israel: a legislative recovery response to the needs-rights paradox. Int Rev Psychiatry, 24(1), 48–55. https://doi.org/10.3109/09540261.2011.652600.

70.

Rose,

L. M.

, Zask,

, Burton,

L. J.

(2017). Psychometricproperties of the Meaning in Life Questionnaire (MLQ) in a sample ofAustralian adolescents. International Journal of Adolescenceand Youth, 22(11), 68–77.

71.

Rosenberg,

, Argentzell,

(2018). Service Users Experience of Peer Support in Swedish Mental Health Care: A “Tipping Point” in the Care-Giving Culture?Journal of Psychosocial Rehabilitation and Mental Health, 5. https://doi.org/10.1007/s40737-018-0109-1.

72.

Rüsch,

, Brohan,

, Gabbidon,

, Thornicroft,

, Clement,

(2014). Stigma and disclosing one’s mental illness to family and friends. Soc Psychiatry Psychiatr Epidemiol, 49(7), 1157–1160. https://doi.org/10.1007/s00127-014-0871-7.

73.

Salzer,

M. S.

, Darr,

, Calhoun,

, Boyer,

, Loss,

R. E.

, Goessel,

, Schwenk,

, Brusilovskiy,

(2013). Benefits of working as a certified peer specialist: Results from a statewide survey. Psychiatric Rehabilitation Journal, 36(3), 219–221. https://doi.org/10.1037/prj0000016.

74.

Salzer,

M. S.

, Schwenk,

, Brusilovskiy,

(2010). Certified peer specialist roles and activities: results from a national survey. Psychiatr Serv, 61(5), 520–523. https://doi.org/10.1176/ps.2010.61.5.520.

75.

Salzer,

M. S.

, Shear,

S. L.

(2002). Identifying consumer-provider benefits in evaluations of consumer-delivered services. Psychiatr Rehabil J, 25(3), 281–288.

76.

Seligman, Martin

E. P.

(2002). Authentic Happiness: Using the New Positive Psychology to Realize Your Potential for Lasting Fulfillment. Free Press.

77.

Shalaby,

R. A. H.

, Agyapong,

V. I. O.

(2020). Peer Support in Mental Health: Literature Review. JMIR Ment Health, 7(6), e15572. https://doi.org/10.2196/15572.

78.

Silverstein,

S. M.

, Bellack,

A. S.

(2008). A scientific agenda for the concept of recovery as it applies to schizophrenia. Clin Psychol Rev, 28(7), 1108–1124. https://doi.org/10.1016/j.cpr.2008.03.004.

79.

Slade,

(2010). Mental illness and well-being: the central importance of positive psychology and recovery approaches. BMC Health Serv Res, 10, 26. https://doi.org/10.1186/1472-6963-10-26.

80.

Slade,

, Oades,

, Jarden,

(2017). Why Wellbeing and Recovery?. In Wellbeing, Recovery and Mental Health (pp. 1-6). Cambridge: Cambridge University Press. https://doi.org/doi:10.1017/9781316339275.002.

81.

Smart,

(2012). Disability across the developmental life span : for the rehabilitation counselor.

82.

Solomon,

(2004). Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatr Rehabil J, 27(4), 392–402.

83.

Steger,

M. F.

, Dik,

B. J.

(2009). If one is looking for meaning in life, does it help to find meaning in work?Applied Psychology: Health and Well-Being, 1(3), 303–320. https://doi.org/10.1111/j.1758-0854.2009.01018.x.

84.

Steger,

M. F.

, Frazier,

, Oishi,

, Kaler,

(2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counselling Psychology, 53(1), 80.

85.

Stevenson,

B. J.

, Millner,

U. C.

, Satgunam,

S. A.

, Love,

(2021). Hope, adaptability, and job-search intensity among individuals living with serious mental illness. Journal of Vocational Rehabilitation, 55(1), 73–79.

86.

Strickler,

D. C.

, Whitley,

, Becker,

D. R.

, Drake,

R. E.

(2009). First person accounts of long-term employment activity amongpeople with dual diagnosis disorder. Psychiatric RehabilitationJournal, 32, 261–268. https://doi.org/10.2975/32.4.2009.261.268.

87.

Torres Stone,

R. A.

, Sabella,

, Lidz,

C. W.

, McKay,

, Smith,L.

(2018). The meaning of work for young adults diagnosed withserious mental health conditions. Psychiatric Rehabilitation Journal, 41(4), 290–298. https://doi.org/10.1037/prj0000195

88.

Thomas,

E. C.

, Snethen,

, Salzer,

M. S.

(2017). A developmental study of community participation of individuals with serious mental illnesses: Implications for policy and practice. American Journal of Orthopsychiatry,, 87(5), 597–605. https://doi.org./10.1037/ort0000269.

89.

Tse,

, Mak,

W. W. S.

, Lo,

I. W. K.

, Liu,

L. L.

, Yuen,

W. W. Y.

, Yau,

, ...

Wong, S.

(2017). A one-year longitudinal qualitative study of peer support services in a non-Western context: The perspectives of peer support workers, service users, and co-workers. Psychiatry Res, 255, 27–35. https://doi.org/10.1016/j.psychres.2017.05.007.

90.

Walter,

, Thomas,

E. C.

, Salzer,

M. S.

(2021). Exploring peer specialists’ experiences with spirituality in their work: Recommendations for future directions. Psychiatric Rehabilitation Journal. Advance online publication. http://dx.doi.org/10.1037/prj0000495.