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Adamus C, Richter D, Sutor K, Zürcher SJ, Mötteli S. Preference for Competitive Employment in People with Mental Disorders: A Systematic Review and Meta-analysis of Proportions. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10192-0. [PMID: 38662329 DOI: 10.1007/s10926-024-10192-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/24/2024] [Indexed: 04/26/2024]
Abstract
PURPOSE The inclusion of people with mental disorders (MD) into competitive employment has become an important political and therapeutic goal. The present paper investigates meta-analytically to which extent people with MD who were unemployed or on sick leave due to MD prefer to work in a competitive job environment. METHODS For this systematic review and meta-analysis of proportions, we searched Medline, PsycInfo, Cinahl, Google Scholar, and reference lists for peer-reviewed publications from 1990 to Dec 2023, which provided data on the job preferences of people with MD. Two authors independently conducted full-text screening and quality assessments. Pooled proportions of job preferences were calculated with a random-effects meta-analysis of single proportions, and subgroup analyses were performed to examine characteristics associated with job preferences. RESULTS We included 30 studies with a total of 11,029 participants in the meta-analysis. The overall proportion of participants who expressed a preference for competitive employment was 0.61 (95%-CI: 0.53-0.68; I2 = 99%). The subgroup analyses showed different preference proportions between world regions where the studies were conducted (p < 0.01), publication years (p = 0.03), and support settings (p = 0.03). CONCLUSION Most people with MD want to work competitively. More efforts should be given to preventive approaches such as support for job retention. Interventions should be initiated at the beginning of the psychiatric treatment when the motivation to work is still high, and barriers are lower. TRAIL REGISTRATION The protocol is published in the Open Science registry at https://osf.io/7dj9r.
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Affiliation(s)
- Christine Adamus
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland.
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), 3098, Köniz, Switzerland.
| | - Dirk Richter
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Kim Sutor
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Simeon Joel Zürcher
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Sonja Mötteli
- Centre for Psychiatric Rehabilitation, Universitäre Psychiatrische Dienste Bern (UPD), Bern, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
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Khare C, Mueser KT, McGurk SR. The relationship between cognitive functioning, age and employment in people with severe mental illnesses in an urban area in India: A longitudinal study. Schizophr Res Cogn 2022; 29:100255. [PMID: 35542828 PMCID: PMC9079721 DOI: 10.1016/j.scog.2022.100255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/25/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022]
Abstract
Although there is substantial evidence of the association between cognitive impairment and work in people with severe mental illnesses (SMI) in developed countries, less is known about this relationship in developing countries such as India. Studies showing higher rates of employment in people with SMI in developing countries than developed ones raise the question of whether cognitive functioning is related to work status and characteristics of work (e.g., wages earned). We conducted a one-year follow-up study to investigate the relationship between employment and cognitive functioning, assessed with the Montreal Cognitive Assessment (MoCA), in 150 participants with SMI (92% schizophrenia) living in an urban area and receiving psychiatric outpatient treatment at a public hospital in India. The MoCA had good internal reliability and test-retest reliability over the one-year period. Better cognitive functioning was associated with younger age, shorter duration of illness, higher education, and male gender. Both younger and older participants with higher cognitive functioning at baseline were more likely to be employed at baseline and one year later. Work status at baseline and one year follow-up was consistently related to executive functions among younger participants, and to attention among older participants, suggesting changes over the course of illness in the importance of specific cognitive domains for achieving satisfactory work performance. The findings suggest that cognitive functioning is associated with employment in people with SMI in India. Attention to impaired cognitive functioning may be critical to improving employment outcomes in this population.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences, Sargent College, Boston University, 635 Commonwealth Ave., Boston, MA 02215, USA
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
- Department of Occupational Therapy, Boston University, Boston, MA 02215, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Susan R. McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
- Department of Occupational Therapy, Boston University, Boston, MA 02215, USA
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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Chimara M, Van Niekerk L, van Biljon HM. Scoping review exploring vocational rehabilitation interventions for mental health service users with chronic mental illness in low-income to upper-middle-income countries. BMJ Open 2022; 12:e059211. [PMID: 35534058 PMCID: PMC9086611 DOI: 10.1136/bmjopen-2021-059211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To synthesise research published on vocational rehabilitation (VR) interventions offered in institutions, by occupational therapists, to mental health service users (MHSUs) with chronic mental illness, in low-income to upper-middle-income countries (L-UMIC). DESIGN This scoping review used Arksey and O'Malley's methodological framework, the Preferred Reporting Items for Systematic Reviews extension for Scoping Reviews and Joanna Briggs scoping review guidelines. DATA SOURCES We searched PsycInfo, EBSCOhost, HINARI, Google Scholar, Medline, CINAHL, PubMed, Cochrane Library, Scopus, Science Direct and Wiley online library between 15 July and 31 August 2021. ELIGIBILITY CRITERIA Sources, published in English between 2011 and 2021, on institution-based VR in occupational therapy for MHSUs who had chronic mental illness in L-UMIC were included. We included primary studies of any design. DATA EXTRACTION AND SYNTHESIS Three reviewers used Mendeley to manage identified references, Rayyan for abstract and full-text screening and Microsoft Excel for data extraction. Data were sifted and sorted by key categories and themes. RESULTS 895 sources were identified, and their title and abstracts reviewed. 207 sources were included for full-text screening. 12 articles from 4 countries (South Africa, India, Brazil and Kenya) were finally included. Types of VR intervention included supported employment, case management and prevocational skills training. Client centeredness, support and empowerment were the key VR principles identified. Teaching of illness self-management, job analysis and matching, job coaching, trial placement, and vocational guidance and counselling were the main intervention strategies reported. CONCLUSIONS VR intervention in institutions for MHSUs in L-UMIC revealed the multidimensional uniqueness of individual MHSU's vocational ability, needs and contexts. The interventions allowed client-centred approaches that offer support and empowerment beyond the boundaries of the institutions. Occupational therapists offering VR need to expand their interventions beyond their institutions to contexts where MHSUs are working or intending to work.
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Affiliation(s)
- Munyaradzi Chimara
- Occupational Therapy & Physiotherapy Department, Faculty of Health Sciences & Veterinary Medicine, University of Namibia, Windhoek, Khomas, Namibia
| | - Lana Van Niekerk
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Hester M van Biljon
- Division of Occupational Therapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
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Bird VJ, Davis S, Jawed A, Qureshi O, Ramachandran P, Shahab A, Venkatraman L. Implementing psychosocial interventions within low and middle-income countries to improve community-based care for people with psychosis-A situation analysis. Front Psychiatry 2022; 13:807259. [PMID: 35978847 PMCID: PMC9376469 DOI: 10.3389/fpsyt.2022.807259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Globally, a treatment gap exists for individuals with severe mental illness, with 75% of people with psychosis failing to receive appropriate care. This is most pronounced in low and middle-income countries, where there are neither the financial nor human resources to provide high-quality community-based care. Low-cost, evidence-based interventions are urgently needed to address this treatment gap. AIM To conduct a situation analysis to (i) describe the provision of psychosocial interventions within the context of existing care in two LMICs-India and Pakistan, and (ii) understand the barriers and facilitators of delivering a new psychosocial intervention. METHOD A situation analysis including a quantitative survey and individual interviews with clinicians, patients and caregivers was conducted. Quantitative survey data was collected from staff members at 11 sites (private and government run hospitals) to assess organizational readiness to implement a new psychosocial intervention. To obtain in-depth information, 24 stakeholders including clinicians and service managers were interviewed about the typical care they provide and/or receive, and their experience of either accessing or delivering psychosocial interventions. This was triangulated by six interviews with carer and patient representatives. RESULTS AND DISCUSSION The results highlight the positive views toward psychosocial interventions within routine care and the enthusiasm for multidisciplinary working. However, barriers to implementation such as clinician time, individual attitudes toward psychosocial interventions and organizational concerns including the lack of space within the facility were highlighted. Such barriers need to be taken into consideration when designing how best to implement and sustain new psychosocial interventions for the community treatment of psychosis within LMICs.
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Affiliation(s)
- Victoria Jane Bird
- Unit for Social and Community Psychiatry, Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom
| | - Syjo Davis
- Schizophrenia Research Foundation, Chennai, India
| | - Abeer Jawed
- Interactive Research and Development, Karachi, Pakistan
| | | | | | - Areeba Shahab
- Interactive Research and Development, Karachi, Pakistan
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Peritogiannis V, Samakouri M. Research on psychotic disorders in rural areas: Recent advances and ongoing challenges. Int J Soc Psychiatry 2021; 67:1046-1057. [PMID: 34024174 DOI: 10.1177/00207640211019456] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Research on patients with chronic psychotic disorders in rural areas is scarce. Those patients may not receive adequate mental health care. Mental health disparities among rural and urban areas have been recognized. AIMS This review aims to present the most recent research on psychotic disorders in rural areas. METHOD We conducted a search in the PubMed and Scopus databases. The search involved articles published over the last decade (2011-2020). All types of research design were included, if studies had used a controlled group of urban patients and reported on the differences among rural/urban residents with psychotic disorders. The focus of the review was on outcome and treatment. RESULTS A total of 12 studies were included in this review. Most have been conducted in China or India. Reports from Western countries are rare. Outcome studies showed that employment rates are significantly higher in rural patients, as well as rates of marriage in women. It is not clear what is the impact of those outcomes on patients' lives. The finding of lower cost of psychotic disorders in some rural areas, should be viewed with scepticism. Studies on treatment aspects suggested that rural patients were less likely to receive antipsychotics, antipsychotic combination or clozapine. Those results were attributed to limited access to specialized treatment. When rural patients receive specialized community care they seem to have better outcomes than urban patients. CONCLUSION There is an ongoing, but still scarce research on patients with chronic psychotic disorders in rural areas. Researchers pointed out the impact of socioeconomic inequalities on outcome and treatment, and stressed the importance of minimizing mental health disparities. These findings may have potential implications for future research; for the introduction of accessible, locally based mental health services in rural areas; and for political initiatives that would address poverty and social inequalities.
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Affiliation(s)
- Vaios Peritogiannis
- Mobile Mental Health Unit of the Prefectures of Ioannina and Thesprotia, Society for the Promotion of Mental Health in Epirus, Ioannina, Greece
| | - Maria Samakouri
- Medical School, Democritus University of Thrace, Alexandroupolis, Greece.,Department of Psychiatry, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
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İNCEDERE A, YILDIZ M. Şizofreni Hastalarında Destekli İşe Yerleştirim: Üç Yıllık İzlem Sonucunun Değerlendirmesi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.30934/kusbed.901262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Khare C, McGurk SR, Fulford D, Watve VG, Karandikar NJ, Khare S, Karandikar DN, Mueser KT. A longitudinal analysis of employment in people with severe mental illnesses in India. Schizophr Res 2021; 228:472-480. [PMID: 33582309 DOI: 10.1016/j.schres.2021.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 01/04/2021] [Accepted: 01/17/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Little is known about the longitudinal trajectories of employment in people with severe mental illnesses (SMI) in developing countries, including India. We examined stability and change in work status, interest in work, problems and benefits related to work among employed participants, and barriers and desired job supports among unemployed participants. METHODS We conducted a one-year follow-up with 550 participants with SMI receiving psychiatric outpatient treatment in two hospitals in two districts in India. A total of 459 (83.5%) participants completed follow-up interviews. RESULTS Rates of employment were stable across the one-year period, with over 60% employed at baseline and follow-up assessment. More than 80% who worked at both assessments were working in the same job for an average duration of 10 years. Among participants who were unemployed at baseline, 16.9% started working at follow-up, an outcome associated with interest in work and efforts to find work at baseline. Interest in work of those unemployed at both assessments was lower at follow-up than baseline, but over 60% of participants wanted to work across both assessments, and endorsed desired supports for their job search. CONCLUSIONS There is considerable stability of work in people with SMI in India. Working in the same job for the long term may have contributed to consistent work. Most unemployed participants who wanted to work at baseline were not working at follow-up, and expressed a desire for help with job search, suggesting the need for vocational services to help people with SMI in developing countries obtain employment.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave., Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA
| | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Department of Occupational Therapy, Boston University, Boston, MA 02215, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Daniel Fulford
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave., Boston, MA 02215, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Vidyadhar G Watve
- Department of Psychiatry, Poona Hospital and Research Centre, Sadashiv Peth, Pune, Maharashtra 411030, India
| | - Neeraj J Karandikar
- Manasdeep Psychiatric and De-addiction Center, Dr. Karandikar Hospital, Laltaki, Siddharthnagar, Ahmednagar, Maharashtra 414001, India
| | - Sailee Khare
- KEM Hospital and Research Centre (KEMHRC), Sardar Moodliar Road, Rasta Peth, Pune, Maharashtra 411011, India
| | - Dipti N Karandikar
- Manasdeep Psychiatric and De-addiction Center, Dr. Karandikar Hospital, Laltaki, Siddharthnagar, Ahmednagar, Maharashtra 414001, India
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Department of Occupational Therapy, Boston University, Boston, MA 02215, USA; Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
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Khare C, Mueser KT, Bahaley M, Vax S, McGurk SR. Employment in people with severe mental illnesses receiving public sector psychiatric services in India. Psychiatry Res 2021; 296:113673. [PMID: 33418456 DOI: 10.1016/j.psychres.2020.113673] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
The limited literature on employment in people with severe mental illnesses (SMI) in developing countries suggests higher rates than in developed countries. The present study explored rates and associated characteristics of work in people receiving public psychiatric services. Semi-structured interviews were conducted with 150 individuals with SMI (90% schizophrenia-spectrum) receiving public outpatient psychiatric services in an urban district in western India to evaluate employment. Forty percent of participants were employed, most for independent employers (86.7%), and were working an average of 53 hours/week. Earning money was reported as the primary motivation to work. A high proportion (92.2%) of unemployed participants wanted to work. Common barriers to work for unemployed participants who were interested in working were psychological (e.g., stress), mental illness (e.g., symptoms), and work-related factors (e.g., difficulty finding a job). Help finding a job and managing mental illness were the primary desired supports. Rates of employment in people with SMI living in urban areas in India are higher than in developed countries, but much lower than the general population. The high interest in work coupled with specific barriers and desired supports point to the need for vocational rehabilitation for improving the employment functioning of people with SMI in India.
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Affiliation(s)
- Chitra Khare
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| | - Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA.
| | | | - Sigal Vax
- College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave. Boston, MA 02215, USA; Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA.
| | - Susan R McGurk
- Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA 02215, USA; Departments of Occupational Therapy and Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA.
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