Employment is a key element in recovery from schizophrenia. Yet 60%–80% of people with schizophrenia are not involved in work occupations. Factors influencing employment were explored mostly in community settings, while the recovery process begins already during hospitalization.
OBJECTIVE:
The aim of the study was to investigate parameters that can distinguish during hospitalization between people with schizophrenia who will work in competitive employment, in sheltered employment or will not work after discharge.
METHODS:
The research followed 104 participants from acute hospitalization to the community, six months after discharge, to obtain employment related data. The participants’ cognitive abilities, schizophrenia symptoms, and functional capacity were evaluated during hospitalization. In addition, demography and illness related factors were collected.
RESULTS:
The results indicate that persons with different employment statuses varied in several parameters during hospitalization. However, the most effective discriminant model includes negative symptoms, functional capacity measure and the number of hospitalizations.
CONCLUSIONS:
The study suggests that people with different employment statuses have unique characteristics already during hospitalization. In the future, appropriate rehabilitation programs may be suggested to each group based on these characteristics to promote employment among people with schizophrenia and contribute to recovery.
BruceMA, BorgB, editors. Psychosocial occupational therapy: Frame of reference for intervention, 2nd ed, Thorofare: Slack Incorporated; 1993, pp. 145–174.
3.
SchretlenD, JayaramG, MakiP, ParkK, AbebeS, DiCarloM. Demographic, clinical, and neurocognitive correlates ofeveryday functional impairment in severe mental illness. J Abnorm Psychol2000;10:134–8.
4.
BondG. Supported employment: Evidence for an evidence based practice. Psychiatr Rehabil J2004;27:345–59.
5.
McGurkSR, MueserKT, DeRosaT, WolfeR. Work, recovery, and comorbidity in schizophrenia. Schizophr Bull2009;35:319–35.
6.
PachoudB, PlagnolA, LeplegeA. Outcome, recovery and return to work in severe mental illnesses. Disabil Rehab2010;32:1043–50.
7.
KrupaT. Employment, recovery and schizophrenia: Integrating health and disorder at work. Psychiatr Rehabil J2004;28:8–15.
8.
BoardmanJ, GroveB, PerkinsR, ShepherdG. Work and employment for people with psychiatric disabilities. Br J Psychiatry2003;182:467–9.
9.
Gutierrez-RecachaP, Ayuso-MateosL. Functional outcomes in schizophrenia. Quart J Ment Health2005;1:11–20.
10.
PalmerBW, HeatonRK, GladsjoJA, EvansJD, PattersonTL, GolshanS, JesteDV. Heterogeneity in functional status among older outpatients with schizophrenia: Employment history, living situation, and driving. Schizophr Res2002;55:205–15.
11.
BellMD, BrysonG. Work rehabilitation in schizophrenia: Does cognitive impairment limit improvement?Schizophr Bull2001;27:269–79.
12.
AnthonyWA, BlanchA. Supported employment for persons who are psychiatrically disabled: An historical and conceptual perspective. Psychiatr Rehab J1987;11:5–23.
13.
MarroneJ, GolowkaE. If work makes people with mental illness sick, what do unemployment, poverty and social isolation cause?Psychiatr Rehab J1999;23:188–93.
14.
BoardmanJ. Work, employment and psychiatric disability. Advanc Psychiatr Treat2001;9:327–34.
15.
Crane-RossD, RothD, LauuberBG. Consumers’ and case managers’ perception of mental health and community support service needs. Community Ment Health J2000;36:161–78.
16.
RosenheckR, LeslieD, KeefeR, McEvoyJ, SwartsM, PerkinsD, StroupS, HsiaoJK, LiebermanJ. Barriers to employment for people with schizophrenia. Am J Psychiatry2006;163:411–7.
17.
LovelandD, DriscollH, BoyleM. Enhancing supported employment services for individuals with a serious mental illness: A review of the literature. J Vocation Rehabil2007;27:177–89.
18.
BowieCR, LeungWW, ReichenbergA, McClureMM, PattersonTL, HeatonRK, HarveyDP. Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry2008;63:505–11.
19.
EvansJD, HeatonRK, PaulsenJS, PalmerBW, PattersonT, JesteDV. The relationship of neuropsychological abilities to specific domains of functional capacity in older schizophrenia patients. Biol Psychiatry2003;53:422–30.
20.
McGurkSR, MueserKT, HarveyPD, LaPugliaR, MarderJ. Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment. Psychiatr Serv2003;54:1129–35.
21.
TwamleyEW, DoshiRR, NayakGV, PalmerBW. Generalized cognitive impairments, ability to perform everyday tasks, and level of independence in community living situations of older patients with psychosis. Am J Psychiatry2002;159:2013–20.
22.
SiegelSJ, IraniF, BrensingerCM, KohlerCG, BilkerWB, RaglandJD, KanesSJ, GurRC, GurRE. Prognostic variables at intake and long-term level of function in schizophrenia. Am J Psychiatry2006;163:433–41.
23.
BowieCR, DeppC, McGrathGA, WolyniecP, MausbachBT, ThornquistMH, LukeJ, PattersonTL, HarveyPD, PulverAD. Prediction of real-world functional disability in chronic mental disorders: A comparison of schizophrenia and bipolar disorder. Am J Psychiatry2010;167:1116–24.
24.
SladeE, SalkeverD. Symptom effects on employment in a structural model of mental illness and treatment: Analysis of patients with schizophrenia. J Ment Health Policy Econom2001;4:25–34.
25.
GreenMF, KernRS, BraffDL, MintzJ. Neurocognitive deficits and functional outcome in schizophrenia: Are we measuring the “right stuff”?Schizophr Bull2000;26:119–36.
26.
GreenMF, KernRS, HeatonRK. Longitudinal studies of cognition and functional outcome in schizophrenia. Schizophr Res2004;72:41–51.
27.
HoferA, BaumgartnerS, BodnerT, EdlingerM, HummerM, KemmlerG, RettenbacherMA. Patient outcomes in schizophrenia II: The impact of cognition. Europ Psychiatry2005;20:395–402.
28.
BellM, TsangHWH, GreigTC, BrysonJG. Neurocognition, social cognition, perceived social discomfort, and vocational outcomes in schizophrenia. Schizophr Bull2009;35:738–47.
29.
LindenmayerJP, McGurkSR, MueserKT, KhanA, WanceD, HoffmanL, WolfR, XieHR. Cognitive remediation among inpatients with persistent mental illness. Psychiatr Serv2008;59:241–7.
30.
DiehlM, WillisSL, SchaieW. Everyday problem solving in older adults: Observational assessments and cognitive correlates. Psychol Aging1995;10:478–91.
31.
DiehlM, MarsiskaM, HorgasAL, RosenbergA, SaczynskiJS, WillisSL. The Revised Observed Tasks of Daily Living: A performance-based assessment of everyday problem solving in older adults. J Applied Gerontology2005;24:211–30.
32.
GoveroverY, JosmanN. Everyday problem solving among for groups of individuals with cognitive impairments: Examination of discriminant validity of the Observed Tasks of Daily Living Revised. Isr J Occup Ther2005;14:17–35.
33.
MitrushinaM, AbaraJ, BlumenfeldA. Aspects of validity and reliability of the Neurobehavioral Cognitive Status Examination (NCSE) in assessment of psychiatric patients. J Psychiatr Res1994;28:85–95.
34.
KatzN, ElazarB, ItzkovichM. Validity of the Neurobehavioral Cognitive Status Examination (COGNISTAT) in assessing patients post CVA and healthy elderly in Israel. Isr J Occup Ther1996;3:185–98.
35.
WallaceJJ, CaroselliJS, ScheibeltRS, HighjrWM. Predictive validity of the Neurobehavioral Cognitive Status Examination (NCSE) in a post-acute rehabilitation setting. Brain Inj2000;14:63–9.
36.
SavageRM, JacksonWT, SourathathoneCM. A brief neuropsychological testing battery for evaluating patients with schizophrenia. Community Ment Health J2003;39:253–62.
37.
BaumC, EdwardsDF. Cognitive performance in senile dementia of Alzheimer’s type: The Kitchen Task Assessment. Am J Occup Ther1993;47:431–6.
38.
KatzN, TadmorI, FelzenB, Hartman-MaeirA. Validity of the Executive Function Performance Test in individuals with schizophrenia. Occup Ther J Res2007;27:1–8.
39.
KaySR, FiszbeinA, OplerLA. The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull1987;13:261–75.
40.
KaySR, OplerLA, LindenmayerJP. Reliability and validity of the Positive and Negative Syndrome Scale for schizophrenia. Psychiatr Res1988;23:99–110.
41.
Hartman-MaeirA, KatzN, BaumC. Cognitive-Functional Evaluation (CFE) for individuals with suspected cognitive disabilities. Occup Ther Health Care2009;23:1–23.
42.
LayB, BlanzB, HartmanM, SchmidtMH. The psychosocial outcome of adolescent onset schizophrenia: A 12 year follow-up. Schizophr Bull2000;26:801–16.
43.
MarwahaS, JohnsonS, BebbingtonP, StaffordM, AngermeyerMC, BrughaT, AzorinJM, KilianR, HansenK, MondherT. Rates and correlates of employment in people with schizophrenia in the UK, Franceand Germany. Br J Psychiatry2007;191:30–7.
44.
SalkeverSD, KarakusMC, SladeEP, HardingCM, HoughRL, RosenheckRA, SwartzMS, BarrioC, YamadaAM. Measures and predictors of community-based employment and earnings of personswith schizophrenia in a multisite study. Psychiatr Serv2007;58:315–24.
45.
CougnardA, GoumillouxR, MonelloF, VerdouxH. Characteristics associated with duration of employment of persons with schizophrenia after first contact with psychiatric services. Work2009;34:365–71.
46.
LysakerPH, DavisLW, BrysonG, BellMD. Effects of cognitive behavioral therapy on work outcomes in vocational rehabilitation for participants with schizophrenia spectrum disorders. Schizophr Res2009;107:186–91.
47.
Wallstedt-PaulssonE, EklundM. Outcome of work rehabilitation for people with various disabilities and stability at a one-year follow-up. Work: A Journal of Prevention, Assessment and Rehabilitation2008;31:473–81.
48.
AsmundsdottirEE. The Worker Role Interview: A powerful tool in Icelandic work rehabilitation. Work2004;22:21–6.
