BACKGROUND: Employment is central to recovery in schizophrenia, but little attention has been paid to its relationship with cognitive functioning.
OBJECTIVE: This cross-sectional study adds to the knowledge base of relationships between cognitive functioning and gaining competitive employment, work hours per week, and monthly income among people with schizophrenia in vocational rehabilitation. It also examines which area of cognitive function may be decisive for gaining employment.
METHODS: Thirty-nine vocational rehabilitation participants were administered a cognitive battery based on MATRICS Consensus Cognitive Battery. Socio-demographic, clinical, and vocational data were gathered and analyzed with nonparametric statistics.
RESULTS: Individuals with competitive employment differed from those without competitive employment in attention and psychomotor speed, delayed verbal recall, immediate visual recall, and planning, reasoning, and problem-solving. Higher scores in immediate and delayed verbal recall and planning, reasoning, and problem-solving correlated with more work hours per week and higher income. Immediate visual recall was related to higher income. Higher scores in planning, reasoning, and problem-solving was an indicator of competitive employment (OR = 1.48).
CONCLUSIONS: Higher order cognitive functioning of planning, reasoning, and problem-solving may have a central role in gaining employment. The findings should be considered in compensation for or improving cognitive functions for vocational rehabilitation participants.
BushPW, DrakeRE, XieH, McHugoGJ, HaslettWR
. The long-term impact of employment on mental health service use and costs for severe mental illness. Psych Serv2009;60(8):1024–31.
2.
McGurkSR, MueserKT
. Cognitive functioning and employment in severe mental illness. J Nerv Ment Dis2003;191(12):789–98.
3.
McGurkSR, MueserKT
. Cognitive functioning, symptoms, and work in supported employment: A review and heuristic model. Schizophr Res2004;70(2-3):147–73.
4.
McGurkSR, MueserKT
. Cognitive and clinical predictors of work outcomes in clients with schizophrenia receiving supported employment services: 4-year follow-up. Adm Policy Ment Health2006;33(5):598–606.
5.
KitchenH, RofailD, HeronL, SaccoP
. Cognitive impairment associated with schizophrenia: A review of the humanistic burden. Adv Ther2012;29(2):148–62.
6.
TanBL
. Profile of cognitive problems in schizophrenia and implications for vocational functioning. Aust Occup Ther J2009;56(4):220–8.
7.
BowieCR, ReichenbergA, PattersonTL, HeatonRK, HarveyPD
. Determinants of real-world functional performance in schizophrenia subjects: Correlations with cognition, functional capacity, and symptoms. Am J Psychiatry2006;163(3):418–25.
8.
EscorpizoR, RenemanMF, EkholmJ, FritzJ, KrupaT, MarnetoftSU, et al. A conceptual definition of vocational rehabilitation based on the ICF: Building a shared global model. J Occup Rehabil2011;21(2):126–33.
SeemanMV
. Employment discrimination against schizophrenia. The Psychiatr Q2009;80(1):9–16.
11.
NuechterleinKH, BarchDM, GoldJM, GoldbergTE, GreenMF, HeatonRK
. Identification of separable cognitive factors in schizophrenia. Schizophr Res2004;72(1):29–39.
12.
KurzbanS, DavisL, BrekkeJ. Vocational, social, and cognitive rehabilitation for individuals diagnosed with schizophrenia: A review of recent research and trends. Curr Psychiatry Rep2010;12, 345–55.
13.
ZaytsevaY, ChanCKR, PöppelE, HeinzA. Luria revisited: Cognitive research in schizophrenia, past implications and future challenges. Philos Ethics Humanit Med2015;10(4):1–11.
14.
YoungJW, GeyerMA
. Developing treatments for cognitive deficits in schizophrenia: The challenge of translation. J Psychopharmacol2015;29(2):178–96.
15.
LettTA, VoineskosAN, KennedyJL, LevineB, DaskalakisZJ
. Treating working memory deficits in schizophrenia: A review of the neurobiology. Biol Psychiatry2014;75(5):361–70.
16.
EackSM
. Cognitive remediation: A new generation of psychosocial interventions for people with schizophrenia. Social Work2012;57(3):235–46.
17.
NuechterleinKH, GreenMF, KernRS, BaadeLE, BarchDM, CohenJD, et al
. The MATRICS Consensus Cognitive Battery, Part 1: Test selection, reliability, and validity. Am J Psychiatry2008;165(2):203–13.
18.
MacDonald-WilsonKL, RogersES, MassaroJM, LyassA, CreanT
. An investigation of reasonable workplace accommodations for people with psychiatric disabilities: Quantitative findings from a multi-site study. Community Ment Health J2002;38(1):35–50.
19.
MacDonald-WilsonK, RogersE, MassaroJ
. Identifying relationships between functional limitations, job accommodations, and demographic characteristics of persons with psychiatric disabilities. J Vocat Rehabil2003;18(1):15–25.
20.
LexénA, HofgrenC, BejerholmU
. Support and process in individual placement and support: A multiple case study. Work2013;44(4):435–48.
21.
LexénA, HofgrenC, BejerholmU
. Reclaiming the worker role: Perceptions of people with mental illness participating in IPS. Scand J Occup Ther2013;20(1):54–63.
22.
ShankarJ
. Improving job tenure for people with psychiatric disabilities through ongoing employment support. AeJAMH2005;4(1):1–11.
23.
KielhofnerG
. Conceptual Foundations of Occupational Therapy Practice.
4th ed. Philadelphia: FA Davis Company; 2009.
24.
LezakDM, HowiesonDB, BiglerED, TranelD
. Neuropsychological Assessment. New York: Oxford University Press, Inc.; 2012.
25.
McGurkSR, MueserKT, HarveyPD, LaPugliaR, MarderJ
. Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment. Psych Serv2003;54(8):1129–35.
26.
KirshB, Stergiou-KitaM, GewurtzR, DawsonD, KrupaT, LysaghtR, et al
. From margins to mainstream: What do we know about work integration for persons with brain injury, mental illness and intellectual disability?Work2009;32(4):391–405.
27.
DelisCD, KaplanE, KramerJH
. Executive Function Systems™. D-KEFS. The Examinera Manual. San Antonio: The Psychological Corporation; 2005.
28.
WechslerD
. Wechsler Adult Intelligence Scale-III. San Antonio, TX, USA: The Psychological Corporation; 1997.
CrippaJA, SanchesRF, HallakJE, LoureiroSR, ZuardiAW
. A structured interview guide increases Brief Psychiatric Rating Scale reliability in raters with low clinical experience. Acta Psychiatr Scand2001;103(6):465–70.
36.
TsangHW, LeungAY, ChungRC, BellM, CheungWM
. Review on vocational predictors: A systematic review of predictors of vocational outcomes among individuals with schizophrenia: An update since 1998. Aust N Z J Psychiatry2010;44(6):495–504.
37.
McGurkSR, MueserKT, DeRosaTJ, WolfeR
. Work, recovery, and comorbidity in schizophrenia: A randomized controlled trial of cognitive remediation. Schizophr Bull2009;35(2):319–35.
38.
BrysonG, BellMD
. Initial and final work performance in schizophrenia: Cognitive and symptom predictors. J Nerv Ment Dis2003;191(2):87–92.
39.
RajjiTK, MirandaD, MulsantBH
. Cognition, function, and disability in patients with schizophrenia: A review of longitudinal studies. Can J Psychiatry2014;59(1):13–17.
40.
KrupaT, KirshB, CockburnL, GewurtzR
. Understanding the stigma of mental illness in employment. Work2009;33(4):413–25.
41.
BergmansY, CarruthersA, JamesJ, WrenK, YagerC, HaslamJ, PépinG, Renéeb, GrignonS. Moving from full-time healing work to paid employment: Challenges and celebrations. Work2009;37(1):389–94.
42.
BeckerDR, DrakeRE, BondGR, NawazS, HaslettWR, MartinezRA
. Best practices: A national mental health learning collaborative on supported employment. Psych Serv2011;62(7):704–6.
43.
KirshB
. Work, workers, and workplaces: A qualitative analysis of narratives of mental health consumers. J of Rehab2000;66(4):24–30.
44.
FettAK, ViechtbauerW, DominguezMD, PennDL, van OsJ, KrabbendamL
. The relationship between neurocognition and social cognition with functional outcomes in schizophrenia: A meta-analysis. Neurosci Biobehav Rev2011;35(3):573–88.
45.
KazdinAE. Research designs in clinical psychology. 4th ed. Boston: A Pearson Education Company; 2009.
46.
DeborahG
. Understanding the ecological validity of neuropsychological testing using an ethnographic approach. Qual Health Res2009;19(10):1495–1503.
47.
WenJH, BooneK, KimK
. Ecological validity of Neuropsychological assessment and perceived employability. J Clin Exp Neuropsychol2006;28, 1423–34.
48.
HaslamJ, PépinG, Renéeb, GrignonS
. Process of task performance as measured by the Assessment of Motor and Process Skills (AMPS): A predictor of work-related outcomes for adults with schizophrenia?Work2010;37(1):53–64.
