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Almalky HA, Alasmari AN. Employers' perceptions of supports provided to their employees with disabilities. RESEARCH IN DEVELOPMENTAL DISABILITIES 2024; 149:104750. [PMID: 38723430 DOI: 10.1016/j.ridd.2024.104750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/16/2024] [Accepted: 04/29/2024] [Indexed: 05/21/2024]
Abstract
The employment of individuals with disabilities is significantly low. Many factors are associated with this issue; however, support and accommodations that can be provided to such individuals can improve their employment rate and outcomes. This study aimed to examine the support provided to employees with disabilities in Saudi Arabia. The descriptive approach was utilized, and a survey was used to collect the data. The sample consisted of 86 employer participants to examine the support of their employees with disabilities. Findings revealed that the support provided was high, and the participants reported that such support facilitates finding and maintaining a job. In addition, the variables were all found to have no significant differences. Providing needed and necessary support is an effective strategy that leads to competitive employment for individuals with disabilities, especially for the long term. Implications and recommendations are also discussed.
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Affiliation(s)
- Hussain A Almalky
- Department of Special Education, College of Education in Al-Kharj, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia.
| | - Ali N Alasmari
- Department of Special Education, College of Education in Al-Kharj, Prince Sattam bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia
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Guinart D, Fagiolini A, Fusar-Poli P, Giordano GM, Leucht S, Moreno C, Correll CU. On the Road to Individualizing Pharmacotherapy for Adolescents and Adults with Schizophrenia - Results from an Expert Consensus Following the Delphi Method. Neuropsychiatr Dis Treat 2024; 20:1139-1152. [PMID: 38812809 PMCID: PMC11133879 DOI: 10.2147/ndt.s456163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 04/27/2024] [Indexed: 05/31/2024] Open
Abstract
Introduction Schizophrenia is a severe mental illness that usually begins in late adolescence or early adulthood. Current pharmacological treatments, while acceptably effective for many patients, are rarely clinically tailored or individualized. The lack of sufficient etiopathological knowledge of the disease, together with overall comparable effect sizes for efficacy between available antipsychotics and the absence of clinically actionable biomarkers, has hindered the advance of individualized medicine in the treatment of schizophrenia. Nevertheless, some degree of stratification based on clinical markers could guide treatment choices and help clinicians move toward individualized psychiatry. To this end, a panel of experts met to formally discuss the current approach to individualized treatment in schizophrenia and to define how treatment individualization could help improve clinical outcomes. Methods A task force of seven experts iteratively developed, evaluated, and refined questionnaire items, which were then evaluated using the Delphi method. Descriptive statistics were used to summarize and rank expert responses. Expert discussion, informed by the results of a scoping review on personalizing the pharmacologic treatment of adults and adolescents with schizophrenia, ultimately generated recommendations to guide individualized pharmacologic treatment in this population. Results There was substantial agreement among the expert group members, resulting in the following recommendations: 1) individualization of treatment requires consideration of the patient's diagnosis, clinical presentation, comorbidities, previous treatment response, drug tolerability, adherence patterns, and social factors; 2) patient preferences should be considered in a shared decision-making approach; 3) identified barriers to personalized care that need to be overcome include the lack of actionable biomarkers and mechanistic similarities between available treatments, but digital tools should be increasingly used to enhance individualized treatment. Conclusion Individualized care can help provide effective, tailored treatments based on an individual's clinical characteristics, disease trajectory, family and social environment, and goals and preferences.
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Affiliation(s)
- Daniel Guinart
- Institut de Salut Mental, Parc de Salut Mar, Barcelona, Spain
- Hospital Del Mar Research Institute, CIBERSAM, Barcelona, Spain
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Andrea Fagiolini
- Department of Molecular Medicine, University of Siena School of Medicine, Siena, Italy
| | - Paolo Fusar-Poli
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Department of Psychosis Studies, King’s College London, London, UK
- Outreach and Support in South-London (OASIS) Service, South London and Maudsley (Slam) NHS Foundation Trust, London, UK
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilian-University Munich, Munich, Germany
| | | | - Stefan Leucht
- Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, Munich, Germany
| | - Carmen Moreno
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (LISGM), Madrid, Spain
- Centro de Investigación Biomedica en Red (CIBERSAM), ISCIII, Madrid, Spain
- School of Medicine, Universidad Complutense, Madrid, Spain
| | - Christoph U Correll
- Department of Psychiatry, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, New York, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitatsmedizin, Berlin, Germany
- German Center for Mental Health (DZPG), Partner Site, Berlin, Germany
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Le TP, Green MF, Wynn JK, Iglesias JE, Franco RL, Kopelowicz A, Kern RS. Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders. Schizophr Res 2023; 262:149-155. [PMID: 37979418 PMCID: PMC10923523 DOI: 10.1016/j.schres.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/29/2023] [Accepted: 11/04/2023] [Indexed: 11/20/2023]
Abstract
Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks - two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) - in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (total R2 = 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.
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Affiliation(s)
- Thanh P Le
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, United States of America; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America.
| | - Michael F Green
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Jonathan K Wynn
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Julio E Iglesias
- Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Richard L Franco
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Alex Kopelowicz
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America
| | - Robert S Kern
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
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Chen CM, Wang JY, Yeh YC, Yang SY. Factors Affecting Employability of Patients with Schizophrenia who had First Participated in Vocational Training: A Pilot Study. Psychiatr Q 2023:10.1007/s11126-023-10020-3. [PMID: 36991281 DOI: 10.1007/s11126-023-10020-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 03/31/2023]
Abstract
While vocational training may offer financial and health benefits for patients with schizophrenia (PwS), further empirical research is required to investigate the effectiveness of this intervention for PwS, as well as the factors influencing their employability. This study aimed to (i) identify the factors affecting the employability of PwS who had participated in vocational training and (ii) examine the effectiveness of vocational training. This prospective cohort study was conducted in a community rehabilitation center attached to a psychiatric hospital in southern Taiwan that provides vocational training. The participants completed two questionnaires: (i) a pre-test that served as the study's baseline; (ii) a post-test during a follow-up 12 months later. The questionnaire was divided into three parts: (i) participants' basic information, (ii) the work performance scale, and (iii) the mental state measure. The participants included 35 males and 30 females, with the average age being 45.85 years. The significant factors affecting their employability were social support, work behavior, thinking disorder, and cognitive impairment. In other words, participants with better social support, work behavior, and fewer thought disorders and cognitive impairment were more employable. Their work attitude and ability were found to have significantly improved after having participated in vocational training for 12 months. In conclusion, when conducting vocational training in the future, it is necessary to pay attention to individual participants' social support and work behavior and reduce thinking disorders and cognitive impairments. This may help improve the employability of PwS.
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Affiliation(s)
- Chin-Mao Chen
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, Taiwan, 41354, Republic of China
| | - Jiun-Yi Wang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, Taiwan, 41354, Republic of China
- Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Ya-Chin Yeh
- Department of Occupational Therapy, Shu-Zen Junior College of Medicine and Management, 452, Huanqiu Rd., Luzhu Dist, Kaohsiung, Taiwan
| | - Shang-Yu Yang
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, 500, Lioufeng Rd., Wufeng, Taichung, Taiwan, 41354, Republic of China.
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Zabihi Poursaadati M, Maarefvand M, Bolhari J, Hosseinzadeh S, Songhori N, Derakhshan L, Khubchandani J. Caregivers' experiences and perspectives of factors associated with relapse in Iranian people living with schizophrenia: A qualitative study. Int J Soc Psychiatry 2023; 69:86-100. [PMID: 34971526 DOI: 10.1177/00207640211068977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Relapse in People Living with Schizophrenia (PLS) has several reasons and recognizing these can increase the effectiveness of treatment interventions. Formal and informal caregivers are an informed source to reduce relapse in PLS. AIM This study explores the caregivers' perspective in Iran on the factors affecting relapse in PLS. METHOD A total of 28 caregivers (16 formal caregivers and 12 informal caregivers) of PLS were enrolled in our qualitative study. A content analysis was conducted using individual and group, semi-structured in-depth interviews with informal and formal caregivers of PLS. This study was conducted in a hospital, three universities, and a non-governmental organization in Tehran, Iran. RESULTS The majority (69%) of the participants were females. About half of the informal caregivers were over 60 years old and about 40% of the formal caregivers were in the age range of 30 to 40 years. The average number of years of work for informal caregivers was 17.6 years and the average of work experience among the formal caregivers was 14.1 years. Seven key dual themes were identified from data: 'awareness-stigma', 'social support-social exclusion', 'treatment adherence-treatment discontinuation', 'holistic approach - one-dimensional approach', 'supported employment-social dysfunction', 'emotional management in family - family with high emotional expression', and 'access to treatment-treatment gap'. CONCLUSION The results of this research can help practitioners and policymakers to enable evidence-based practices to reduce relapse in PLS by emphasizing and acting on factors identified in our analyses.
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Affiliation(s)
| | - Masoomeh Maarefvand
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Samaneh Hosseinzadeh
- Biostatistics department, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Nahid Songhori
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Leili Derakhshan
- Department of Social Work, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Jagdish Khubchandani
- Department of Public Health Sciences, New Mexico University, Las Cruces, NM, USA
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Bond GR, Mascayano F, Metcalfe JD, Riley J, Drake RE. Access, retention, and effectiveness of individual placement and support in the US: Are there racial or ethnic differences? JOURNAL OF VOCATIONAL REHABILITATION 2023. [DOI: 10.3233/jvr-230007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND: Increased federal attention to advancing racial equity and support for underserved communities suggests the need for data on racial and ethnic differences in evidence-based employment services for people with serious mental illness. Individual Placement and Support (IPS) is an evidence-based model of supported employment for this population. OBJECTIVE: The objective was to identify differences based on race and ethnicity in IPS services. METHODS: This narrative review examined the empirical literature on IPS services in the U.S., assessing evidence of differences in access, retention, and outcomes for Black and Hispanic IPS clients, relative to non-Hispanic Whites. RESULTS: We identified 12 studies examining racial and ethnic differences in access (4 studies), retention (3 studies), and effectiveness (6 studies). The findings for access to IPS were mixed, with two studies showing no differences, one finding less access for Blacks, and another finding greater access for Blacks but less access for Hispanics. Three studies found better retention rates for clients enrolled in IPS regardless of race or ethnicity. Compared to clients receiving usual vocational services, all studies found better employment outcomes for IPS clients regardless of race or ethnicity. CONCLUSION: Unlike for most of health care, few racial and ethnic differences have been found for IPS employment services in the U.S. Access to IPS is inadequate for all groups, with conflicting evidence whether Blacks and Hispanics have even less access. Based on the available evidence, Black and Hispanic clients have comparable retention and employment outcomes in IPS as non-Hispanic White clients. State and local mental health leaders responsible for monitoring IPS outcomes should routinely report statistics on race and ethnicity. They should also give active attention to client needs and equity. Research designs should answer multifaceted questions regarding disparities for historically underserved populations.
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Rennhack F, Lindahl-Jacobsen LE, Schori D. Pre-vocational therapy in mental health. Clients' desired and achieved productivity status. Scand J Occup Ther 2023; 30:195-210. [PMID: 34602019 DOI: 10.1080/11038128.2021.1968950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Knowledge about work-related occupational therapy in psychiatric inpatient and day hospital clients is limited. AIMS The aim of the study was to explore the desired and achieved productivity status in mental health service users participating in a pre-vocational therapy (PVT) intervention. Outcome variables were productivity status and achievement of desired productivity status at discharge, and change or persistence of productivity status between admission and discharge. METHODS This is a short-term prospective study based on observational data from health records (N = 98). RESULTS At admission, 53.2% of participants named a clear desired productivity status; 46.8% did not. Of the former, 76.9% expressed a desire for employment or education on the regular job market; 28.0% achieved their desired outcome at discharge, whereas 72.0% did not. Overall, 58.5% retained, established or increased productive activities, while 41.5% were not engaged in or had reduced productive activities at discharge. These two groups differed in socio-economic and social-security-related characteristics, treatment-related characteristics and psychiatric diagnosis. CONCLUSIONS AND SIGNIFICANCE Some, but not all kinds of clients in acute psychiatric inpatient and day hospital settings manage to take a first step towards productive activities during the first phase of treatment.
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Affiliation(s)
- Frauke Rennhack
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | | | - Dominik Schori
- Directorate of Nursing, Therapies and Social Work, University Hospital of Psychiatry Zurich, Zurich, Switzerland
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8
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Witte I, Strandberg T, Granberg S, Gustafsson J. Intersectional perspectives on the employment rate in Supported Employment for people with psychiatric, neuropsychiatric, or intellectual disabilities: A scoping review. Work 2023; 74:435-454. [PMID: 36278382 PMCID: PMC9986703 DOI: 10.3233/wor-211155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Supported Employment (SE) has shown better results in the employment rate for persons with disabilities than other methods within vocational rehabilitation, but how SE affects the employment rate for subgroups in the interventions needs further attention. OBJECTIVE To examine previous research regarding the influence of intersecting statuses on the employment rate in SE for people with psychiatric, neuropsychiatric, or intellectual disabilities according to type of diagnosis, sex, race/ethnicity, age, level of education and previous work history. METHODS A systematic literature search was conducted in nine databases including peer-reviewed articles from 2000 to April 2021. Articles presenting the employment rate in SE interventions according to the intersecting statuses listed in the objective were included. RESULTS The searches identified 3777 unique records, of which 53 articles were included in data extraction. In most of the included articles, intersecting statuses did not affect the employment rate for people in the SE interventions with psychiatric disabilities. Few studies have examined neuropsychiatric and intellectual disabilities. A majority of the studies subjected to full-text analysis were excluded due to a lack of reporting of the effects of intersecting statuses on the employment rate. The studies that reported on the effects of intersecting statuses on the employment rate often had small samples and lacked statistical power. CONCLUSIONS Intersecting statuses do not appear to affect the employment rate for people receiving SE interventions, but systematic reviews with pooled samples need to be undertaken because of the low reporting rate and underpowered sample sizes in existing studies.
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Affiliation(s)
- Ingrid Witte
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden
| | - Thomas Strandberg
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sarah Granberg
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Johanna Gustafsson
- School of Health Sciences, Örebro University, Örebro, Sweden.,The Swedish Institute for Disability Research, Örebro University, Örebro, Sweden.,Audiological Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Centre for the Study of Professions, Oslo Metropolitan University, Oslo, Norway
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Reynolds CF, Jeste DV, Sachdev PS, Blazer DG. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry 2022; 21:336-363. [PMID: 36073714 PMCID: PMC9453913 DOI: 10.1002/wps.20996] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.
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Affiliation(s)
| | - Dilip V. Jeste
- Department of PsychiatryUniversity of California San DiegoLa JollaCAUSA
| | | | - Dan G. Blazer
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNCUSA
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de Winter L, Couwenbergh C, van Weeghel J, Sanches S, Michon H, Bond GR. Who benefits from individual placement and support? A meta-analysis. Epidemiol Psychiatr Sci 2022; 31:e50. [PMID: 35815640 PMCID: PMC9281491 DOI: 10.1017/s2045796022000300] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/16/2022] [Accepted: 05/22/2022] [Indexed: 01/22/2023] Open
Abstract
AIMS Individual placement and support (IPS) is an evidence-based service model to support people with mental disorders in obtaining and sustaining competitive employment. IPS is increasingly offered to a broad variety of service users. In this meta-analysis we analysed the relative effectiveness of IPS for different subgroups of service users both based on the diagnosis and defined by a range of clinical, functional and personal characteristics. METHODS We included randomised controlled trials that evaluated IPS for service users diagnosed with any mental disorder. We examined effect sizes for the between-group differences at follow-up for three outcome measures (employment rate, job duration and wages), controlling for methodological confounders (type of control group, follow-up duration and geographic region). Using sensitivity analyses of subgroup differences, we analysed moderating effects of the following diagnostic, clinical, functional and personal characteristics: severe mental illness (SMI), common mental disorders (CMD), schizophrenia spectrum disorders, mood disorders, duration of illness, the severity of symptoms, level of functioning, age, comorbid alcohol and substance use, education level and employment history. RESULTS IPS is effective in improving employment outcomes compared to the control group in all subgroups, regardless of any methodological confounder. However, IPS was relatively more effective for service users with SMIs, schizophrenia spectrum disorders and a low symptom severity. Although IPS was still effective for people with CMD and with major depressive disorder, it was relatively less effective for these subgroups. IPS was equally effective after both a short and a long follow-up period. However, we found small, but clinically not meaningful, differences in effectiveness of IPS between active and passive control groups. Finally, IPS was relatively less effective in European studies compared to non-European studies, which could be explained by a potential benefits trap in high welfare countries. CONCLUSIONS IPS is effective for all different subgroups, regardless of diagnostic, clinical, functional and personal characteristics. However, there might be a risk of false-positive subgroup outcomes and results should be handled with caution. Future research should focus on whether, and if so, how the IPS model should be adapted to better meet the vocational needs of people with CMD and higher symptom severity.
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Affiliation(s)
- Lars de Winter
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Chrisje Couwenbergh
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Jaap van Weeghel
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Sarita Sanches
- Phrenos Center of Expertise for Severe Mental Illnesses, Utrecht, the Netherlands
| | - Harry Michon
- Movisie Netherlands Centre for Social Development, Utrecht, the Netherlands
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Metcalfe JD, Drake RE. Participation in Individual Placement and Support in the Supported Employment Demonstration. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:521-529. [PMID: 34855098 DOI: 10.1007/s10488-021-01180-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
Individual placement and support (IPS) was the primary intervention in the United States Social Security Administration's supported employment demonstration (SED), a large randomized trial that sought to increase employment and reduce disability among those whose first application for disability benefits was denied. Researchers developed a measure of participation in IPS services to quantify participation among enrollees assigned to receive IPS. The IPS participation measure, which IPS teams completed monthly for individual clients, recorded clients assigned to IPS as being either out of contact with their IPS treatment teams or, if in contact, according to their employment status (employed or not employed) and receipt of IPS job search services (participating or not participating). The measure also recorded types of IPS activities and reasons for non-participation. IPS teams completed the IPS participation measure at a rate of approximately 95% each month. Between 27 and 35% of enrollees assigned to a treatment condition participated in IPS services each month during the first 24 months of measurement. The most common activities were applying for jobs and attending job interviews. Most of those out of contact were not responding to outreach efforts (58-72%). Those in contact but not participating despite being unemployed were typically either uninterested in employment (20-44%) or difficult to reach (10-16%). As IPS expands to serve new populations, it will be important to document and understand the links between individual characteristics, variance in participation patterns, and employment outcomes. Subsequent analyses of SED data will investigate these relationships among enrollees.
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Affiliation(s)
- Justin D Metcalfe
- Westat Inc, 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH, 03766, USA.
| | - Robert E Drake
- Westat Inc, 85 Mechanic Street, Suite C3-1, Box4A, Lebanon, NH, 03766, USA
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Weld-Blundell I, Shields M, Devine A, Dickinson H, Kavanagh A, Marck C. Vocational Interventions to Improve Employment Participation of People with Psychosocial Disability, Autism and/or Intellectual Disability: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212083. [PMID: 34831840 PMCID: PMC8618542 DOI: 10.3390/ijerph182212083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/11/2021] [Accepted: 11/14/2021] [Indexed: 11/16/2022]
Abstract
Objective: To systematically review interventions aimed at improving employment participation of people with psychosocial disability, autism, and intellectual disability. Methods: We searched MEDLINE, Embase, PsycINFO, Web of Science, Scopus, CINAHL, ERIC, and ERC for studies published from 2010 to July 2020. Randomized controlled trials (RCTs) of interventions aimed at increasing participation in open/competitive or non-competitive employment were eligible for inclusion. We included studies with adults with psychosocial disability autism and/or intellectual disability. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias II Tool. Data were qualitatively synthesized. Our review was registered with PROSPERO (CRD42020219192). Results: We included 26 RCTs: 23 targeted people with psychosocial disabilities (n = 2465), 3 included people with autism (n = 214), and none included people with intellectual disability. Risk of bias was high in 8 studies, moderate for 18, and low for none. There was evidence for a beneficial effect of Individual Placement and Support compared to control conditions in 10/11 studies. Among young adults with autism, there was some evidence for the benefit of Project SEARCH and ASD supports on open employment. Discussion: Gaps in the availability of high-quality evidence remain, undermining comparability and investment decisions in vocational interventions. Future studies should focus on improving quality and consistent measurement, especially for interventions targeting people with autism and/or intellectual disability.
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Affiliation(s)
- Isabelle Weld-Blundell
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Marissa Shields
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Alexandra Devine
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
- Correspondence:
| | - Helen Dickinson
- School of Business, University of New South Wales, Canberra 2610, Australia;
| | - Anne Kavanagh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
| | - Claudia Marck
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne 3010, Australia; (I.W.-B.); (M.S.); (A.K.); (C.M.)
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13
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Badu E, O’Brien AP, Mitchell R. An Integrative Review of Recovery Services to Improve the Lives of Adults Living with Severe Mental Illness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168873. [PMID: 34444622 PMCID: PMC8393579 DOI: 10.3390/ijerph18168873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/16/2021] [Accepted: 08/18/2021] [Indexed: 12/02/2022]
Abstract
There is an increasing call for recovery-oriented services but few reviews have been undertaken regarding such interventions. This review aims to synthesize evidence on recovery services to improve the lives of adults living with severe mental illness. An integrative review methodology was used. We searched published literature from seven databases: Medline, EMBASE, PsycINFO, CINAHL, Google Scholar, Web of Science, and Scopus. Mixed-methods synthesis was used to analyse the data. Out of 40 included papers, 62.5% (25/40) used quantitative data, 32.5% used qualitative and 5% (2/40) used mixed methods. The participants in the included papers were mostly adults with schizophrenia and schizoaffective disorder. This review identified three recovery-oriented services—integrated recovery services, individual placement services and recovery narrative photovoice and art making. The recovery-oriented services are effective in areas such as medication and treatment adherence, improving functionality, symptoms reduction, physical health and social behaviour, self-efficacy, economic empowerment, social inclusion and household integration. We conclude that mental health professionals are encouraged to implement the identified recovery services to improve the recovery goals of consumers.
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Affiliation(s)
- Eric Badu
- School of Nursing and Midwifery, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW 2308, Australia
- Correspondence: ; Tel.: +61-452414632
| | - Anthony Paul O’Brien
- Faculty of Health, Southern Cross University, East Lismore, NSW 2480, Australia;
| | - Rebecca Mitchell
- Faculty of Business and Economics, Macquarie University, Macquarie Park, NSW 2109, Australia;
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Soutien en emploi : une nouvelle approche vers l’inclusion. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.02.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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15
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Williams A, Lowry T, Sims-Robinson C. The development of a cognitive rehabilitation task for mice. Neurobiol Learn Mem 2020; 175:107296. [PMID: 32784042 PMCID: PMC7655560 DOI: 10.1016/j.nlm.2020.107296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/31/2020] [Accepted: 08/05/2020] [Indexed: 11/17/2022]
Abstract
Obesity, neurodegenerative diseases, and injury can all lead to cognitive deficits, which can be improved clinically with the implementation of cognitive rehabilitation. Due to a lack of effective cognitive rehabilitation tools in mice, we re-designed a cognitive task utilized to detect problem-solving deficits, to develop a cognitive rehabilitation paradigm for mice. In this study, we developed a modified the Puzzle Box task by exposing B6 mice to a variety of obstacles and assessing the escape latencies. We then combined obstacles in order to create a "complex obstacle" for the problem-solving task. We determined that our task was reproducible in different cohorts of mice. Furthermore, with repetition the mice display an improvement in the performance, evident by a shorter escape latency and the ability to maintain this improvement in performance, indicative of long-term memory. Given that this approach is new, we validated whether this task could successfully detect deficits in a mouse model of cognitive impairment, the high-fat diet mouse. We demonstrate that high-fat diet mice have longer escape latencies when exposed to the complex obstacle compared to standard diet control mice. Taken together, these data suggest that the Puzzle Box is a valid task for cognitive rehabilitation in mice.
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Affiliation(s)
- Alexus Williams
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Taylor Lowry
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA; College of Charleston, Charleston, SC 29425, USA
| | - Catrina Sims-Robinson
- Department of Neurology, Medical University of South Carolina, Charleston, SC 29425, USA.
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16
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Bornheimer LA, Zhang A, Li J, Hiller M, Tarrier N. Effectiveness of Suicide-Focused Psychosocial Interventions in Psychosis: A Systematic Review and Meta-Analysis. Psychiatr Serv 2020; 71:829-838. [PMID: 32340594 DOI: 10.1176/appi.ps.201900487] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Suicide ideation, plan, attempt, and death are significant and prevalent concerns among individuals with psychosis. Previous studies have focused on risk factors, but few have systematically evaluated the effect of psychosocial interventions on these experiences among individuals with psychosis. This study evaluated the effectiveness of psychosocial interventions in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. METHODS Eight electronic databases were systematically searched from inception until June 30, 2019. Identified studies included both randomized controlled trials and controlled trials without randomization that examined psychosocial interventions for suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. A random-effects model was used to pool the effect sizes for synthesis. RESULTS Eleven studies with 14 effect sizes (N=4,829 participants) were analyzed. The average age of participants ranged from 21 to 51, and most participants identified as male and non-Hispanic Caucasian or Chinese and were in an early or first-episode stage of illness. On average, participants who received psychosocial interventions were less likely than their counterparts in the control group to report suicide ideation, plan, and attempt and die by suicide (odds ratio [OR]=0.57, 95% confidence interval [CI]=0.41-0.78). Subgroup analyses further revealed significant reductions in suicide ideation (OR=0.73, 95% CI=0.55-0.97) and suicide death (OR=0.45, 95% CI=0.30-0.68) among intervention participants. CONCLUSIONS Preliminary evidence indicated that psychosocial interventions are effective in reducing suicide ideation, plan, attempt, and death among individuals with psychotic symptoms. Intervention characteristics, however, varied across studies, which suggests a lack of consensus on best clinical practices.
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Affiliation(s)
- Lindsay A Bornheimer
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Anao Zhang
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Juliann Li
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Matthew Hiller
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
| | - Nicholas Tarrier
- School of Social Work, University of Michigan, Ann Arbor (Bornheimer, Zhang, Li, Hiller); School of Psychological Science, University of Manchester, Manchester, England (Tarrier)
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17
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Gyamfi N, Badu E, Mprah WK, Mensah I. Recovery services and expectation of consumers and mental health professionals in community-based residential facilities of Ghana. BMC Psychiatry 2020; 20:355. [PMID: 32631367 PMCID: PMC7339466 DOI: 10.1186/s12888-020-02768-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 06/29/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND In the past decades, considerable global attention has been drawn to recovery services that seek to promote the personal recovery journey of consumers with mental illness. However, in most settings, including Ghana, limited empirical studies have attempted to explore, from the perspectives of Mental Health Professionals (MHPs) and consumers, the effectiveness of recovery services and expectation towards the recovery. This study, therefore, explored consumers' and MHPs perspectives concerning recovery services and expectations towards recovery in two community-based residential facilities in Ghana. METHODS A qualitative method, involving in-depth interviews and observations, were used to collect data from 24 participants (5 MHPs and 19 consumers). Thematic analysis was used to analyze the data. RESULTS The study identified three global themes and nine organizing themes. The global themes were recovery services offered to consumers, expectation regarding personal recovery and challenges in achieving recovery. The study found that recovery services were expected to improve the internal and external recovery processes of consumers. The internal recovery process was independent living whilst the external recovery process were management of illness, economic empowerment and social inclusion. Several systemic and consumer-related factors influenced consumers' and MHPs expectation concerning the recovery journey. CONCLUSION The study concludes that the government should prioritize the use of recovery services through policies, financial incentives, infrastructure support, and adequate training of MHPs.
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Affiliation(s)
- Naomi Gyamfi
- grid.9829.a0000000109466120Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana ,grid.1020.30000 0004 1936 7371School of Health, University of New England, Armidale, Australia
| | - Eric Badu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. .,School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia.
| | - Wisdom Kwadwo Mprah
- grid.9829.a0000000109466120Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Isaac Mensah
- Department of Special Education, University of Education, Winneba, Ghana
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18
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Lannigan EG, Noyes S. Occupational Therapy Interventions for Adults Living With Serious Mental Illness. Am J Occup Ther 2019; 73:7305395010p1-7305395010p5. [PMID: 31484037 DOI: 10.5014/ajot.2019.735001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Occupational therapy practitioners have education, skills, and knowledge to provide occupational therapy interventions for adults living with serious mental illness. Evidence-based interventions demonstrate that occupational therapy practitioners can enable this population to engage in meaningful occupations, participate in community living, and contribute to society. Systematic review findings for occupational therapy interventions for adults living with serious mental illness were published in the September/October 2018 issue of the American Journal of Occupational Therapy and in the Occupational Therapy Practice Guidelines for Adults Living With Serious Mental Illness. Each article in the Evidence Connection series summarizes evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how research evidence from the reviews can be used to inform and guide clinical decision making. Through a case story, this article illustrates how current evidence is applied for effective occupational therapy intervention with an adult living with serious mental illness.
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Affiliation(s)
- Elizabeth Griffin Lannigan
- Elizabeth Griffin Lannigan, PhD, OTR/L, FAOTA, is Adjunct Faculty, Department of Occupational Therapy, College of Health and Human Services, University of New Hampshire, Durham;
| | - Susan Noyes
- Susan Noyes, PhD, OTR/L, is Associate Professor, Master of Occupational Therapy Program, University of Southern Maine, Lewiston
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19
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Mahmood Z, Keller AV, Burton CZ, Vella L, Matt GE, McGurk SR, Twamley EW. Modifiable Predictors of Supported Employment Outcomes Among People With Severe Mental Illness. Psychiatr Serv 2019; 70:782-792. [PMID: 31185856 PMCID: PMC6718295 DOI: 10.1176/appi.ps.201800562] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Among people with severe mental illnesses, neuropsychological abilities may contribute to vocational outcomes, such as job attainment, job tenure, and wages earned. The current study aimed to determine the strongest neuropsychological and other modifiable predictors of work outcomes in 153 people with severe mental illness (schizophrenia, 38%; bipolar disorder, 24%; and major depression, 38%) who participated in a 2-year supported employment study. METHODS Assessments of neuropsychological performance, functional capacity, social skills, and psychiatric symptom severity were administered at baseline; work outcomes (job attainment, weeks worked, and wages earned) were collected weekly for 2 years. RESULTS Independent of education, diagnosis, and estimated intellectual functioning, more recent work history and less severe negative symptoms significantly predicted job attainment during the 2-year study. Among the 47% who obtained jobs, better global neuropsychological performance (i.e., lower global deficit score) was a significant predictor of greater weeks worked. Both global neuropsychological performance and more recent work history predicted higher wages earned. CONCLUSIONS Modifiable predictors of supported employment outcomes included cognitive functioning and negative symptom severity; thus, interventions to improve these factors may improve work outcomes and decrease the loss of productivity associated with severe mental illness.
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Affiliation(s)
- Zanjbeel Mahmood
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Amber V Keller
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Cynthia Z Burton
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Lea Vella
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Georg E Matt
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Susan R McGurk
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
| | - Elizabeth W Twamley
- San Diego State University and University of California, San Diego (SDSU/UC San Diego), Joint Doctoral Program in Clinical Psychology, San Diego (Mahmood); Research Service (Mahmood, Keller) and Center of Excellence for Stress and Mental Health (Twamley), U.S. Department of Veterans Affairs San Diego Healthcare System, San Diego; Department of Psychiatry, University of California, San Diego (Twamley); Department of Psychiatry, University of Michigan, Ann Arbor (Burton), Department of Quality, University of California, San Francisco Health, San Francisco (Vella); Department of Psychology, San Diego State University, San Diego (Matt); Department of Occupational Therapy and Psychological and Brain Sciences, Center for Psychiatric Rehabilitation, Boston University, Boston (McGurk). Drs. Burton and Vella were with the SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology at the time of this research
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20
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Frederick DE, VanderWeele TJ. Supported employment: Meta-analysis and review of randomized controlled trials of individual placement and support. PLoS One 2019; 14:e0212208. [PMID: 30785954 PMCID: PMC6382127 DOI: 10.1371/journal.pone.0212208] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022] Open
Abstract
Supported employment is a treatment whereby those with severe mental illness (or other disabilities) receive aid searching for competitive employment and mental health (or other) treatments concurrently. The most popular implementation of supported employment is individual placement and support (IPS). We conducted meta-analytic analyses of the randomized controlled trials of IPS. We found that subjects in IPS, compared to usual treatment conditions, had better vocational outcomes (obtained any competitive employment: RR = 1.63, 95%CI = [1.46, 1.82]; job tenure: d = 0.55, 95%CI = [0.33, 0.79]; job length: d = 0.46, 95%CI = [0.35, 0.57]; income: d = 0.48, 95%CI = [0.36, 0.59]) Non-vocational outcomes estimates, while favoring IPS, included the null (quality of life: d = 0.30, 95%CI = [-0.07, 0.67]; global functioning: d = 0.09, 95%CI = [-0.09, 0.27]; mental health: d = 0.03, 95%CI = [-0.15, 0.21]). Analysis of the expected proportion of studies with a true effect on non-vocational outcomes with d>0.2 showed some reason to expect a possible improvement for quality of life for at least some settings (Prop = 0.57, 95%CI = [0.30, 0.84]).
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Affiliation(s)
- Donald E. Frederick
- Human Flourishing Program, The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America
| | - Tyler J. VanderWeele
- Human Flourishing Program, The Institute for Quantitative Social Science, Harvard University, Cambridge, MA, United States of America
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, United States of America
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21
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Noyes S, Sokolow H, Arbesman M. Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018; 72:7205190010p1-7205190010p10. [PMID: 30157005 DOI: 10.5014/ajot.2018.033068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Many of the estimated 9.8 million American adults with serious mental illness (SMI) want to engage in employment and education, yet the majority report a need for more skills training. This review presents evidence for the effectiveness of interventions that occupational therapy practitioners can provide to help people with SMI improve and maintain performance and participation in employment and education. METHOD Citations, abstracts, and full-text articles in databases including MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were reviewed for inclusion and analysis. RESULTS Fifty-seven articles met criteria for inclusion. For employment, strong evidence was found for the Individual Placement and Support (IPS) model and cognitive interventions. For education, moderate evidence was found for supported education interventions. CONCLUSION This systematic review supports the role of occupational therapy practitioners in promoting the implementation of IPS, cognitive-based, and social skills programs to improve vocational and educational outcomes for adults with SMI.
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Affiliation(s)
- Susan Noyes
- Susan Noyes, PhD, OTR/L, is Assistant Professor, Occupational Therapy Program, University of Southern Maine, Lewiston;
| | - Helena Sokolow
- Helena Sokolow, MOT, OTR, is Adjunct Instructor, Occupational Therapy Program, University of Southern Maine, Lewiston
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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Metcalfe JD, Drake RE, Bond GR. Economic, Labor, and Regulatory Moderators of the Effect of Individual Placement and Support Among People With Severe Mental Illness: A Systematic Review and Meta-analysis. Schizophr Bull 2018; 44:22-31. [PMID: 29036727 PMCID: PMC5768052 DOI: 10.1093/schbul/sbx132] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
As Individual Placement and Support (IPS) has become the international standard for vocational rehabilitation of adults with serious mental illness, researchers must consider the relationship between IPS and local environments. This meta-analysis used mixed-effects meta-regressions to assess the impact of site-level moderators on the likelihood that IPS recipients, compared with recipients of alternative vocational services, achieved competitive employment. Potential moderators included change in gross domestic product (GDP), local unemployment and unionization rates, and indices describing employment protection regulations, level of disability benefits compensation, and efforts to integrate people with disabilities into the workforce. Regulatory moderators represent facilitators and barriers to employment that may reinforce or detract from the effectiveness of IPS. Across 30 sites drawn from 21 randomized controlled trials in 12 countries (33% in the United States), IPS recipients were 2.31 (95% CI 1.99-2.69) times more likely to find competitive employment than recipients of alternative vocational rehabilitation services. The significant competitive-employment rate advantage of IPS over control services increased in the presence of weaker employment protection legislation and integration efforts, and less generous disability benefits. Policy makers should recognize and account for the fact that labor and disability regulations can create an arrangement of incentives that reduces the relative efficacy of supported employment.
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Affiliation(s)
- Justin D Metcalfe
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH
| | - Robert E Drake
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH.,IPS Employment Center, Westat Inc., Lebanon, NH
| | - Gary R Bond
- IPS Employment Center, Westat Inc., Lebanon, NH
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23
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Assessing the Relationship between Performance on the University of California Performance Skills Assessment (UPSA) and Outcomes in Schizophrenia: A Systematic Review and Evidence Synthesis. SCHIZOPHRENIA RESEARCH AND TREATMENT 2018; 2018:9075174. [PMID: 30687553 PMCID: PMC6327277 DOI: 10.1155/2018/9075174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/12/2018] [Accepted: 12/05/2018] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To perform a systematic review of the published literature to evaluate how functional capacity, as measured by the University of California at San Diego (UCSD) Performance-based Skills Assessment (UPSA), relates to other functional measures and real-world outcomes among individuals with schizophrenia. METHODS The MEDLINE® and Embase® databases were searched to identify joint evaluations with UPSA and key functional outcomes (functional scale measures; generic or disease-specific, health-related quality of life [HRQoL]; or real-world outcomes [residential status; employment status]) in patients with schizophrenia. Pearson correlations were estimated between UPSA scores, HRQoL, other functional scale measures, and real-world outcomes, for outcomes described in at least six studies. RESULTS The synthesis included 76 studies that provided 73 unique data sets. Quantitative assessment between the Specific Level of Function (SLOF) (n=18) scores and UPSA scores demonstrated a moderate borderline-significant correlation (0.45, p=0.06). Quantitative analysis of the relationship between the Global Assessment of Functioning (GAF) (n=11) and the Multidimensional Scale of Independent Functioning (MSIF) (n=6) scales revealed moderate and small nonsignificant Pearson correlations of -0.34 (p=0.31) and 0.12 (p=0.83), respectively. There was a small borderline-significant correlation between UPSA score and residential status (n=36; 0.31; p=0.08), while no correlation was found between UPSA score and employment status (n=19; 0.04; p=0.88). CONCLUSION The SLOF was the most often used functional measure and had the strongest observed correlation with the UPSA. Although knowledge gaps remain, evidence from this review indicates that there is a quantitative relationship between functional capacity and real-world outcomes in individuals with schizophrenia.
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Kern RS, Zarate R, Glynn SM, Turner LR, Smith KM, Mitchell SS, Sugar CA, Bell MD, Liberman RP, Kopelowicz A, Green MF. Improving Work Outcome in Supported Employment for Serious Mental Illness: Results From 2 Independent Studies of Errorless Learning. Schizophr Bull 2018; 44:38-45. [PMID: 28981901 PMCID: PMC5768051 DOI: 10.1093/schbul/sbx100] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Heterogeneity in work outcomes is common among individuals with serious mental illness (SMI). OBJECTIVE In 2 studies, we sought to examine the efficacy of adding errorless learning, a behavioral training intervention, to evidence-based supported employment to improve SMI work outcomes. Work behavior problems were targeted for intervention. We also explored associations between early work behavior and job tenure. METHODS For both studies (VA: n = 71; community mental health center: n = 91), randomization occurred at the time of job obtainment with participants randomized (1:1) to either errorless learning plus ongoing supported employment or ongoing supported employment alone and then followed for 12 months. Dependent variables included job tenure, work behavior, and hours worked and wages earned per week. For the primary intent-to-treat analyses, data were combined across studies. RESULTS Findings revealed that participants in the errorless learning plus supported employment group stayed on their jobs significantly longer than those in the supported employment alone group (32.8 vs 25.6 wk). In addition, differential treatment effects favoring errorless learning were found on targeted work behavior problems (50.5% vs 27.4% improvement from baseline to follow-up assessment). There were no other differential treatment effects. For the prediction analyses involving work behavior, social skills explained an additional 18.3% of the variance in job tenure beyond levels of cognition, symptom severity, and past work history. CONCLUSIONS These data support errorless learning as an adjunctive intervention to enhance supported employment outcomes and implicate the relevance of workplace social difficulties as a key impediment to prolonged job tenure.
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Affiliation(s)
- Robert S Kern
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA,Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA,To whom correspondence should be addressed; VA Greater Los Angeles Healthcare System (MIRECC 210A), 11301 Wilshire Blvd., Building 210, Room 221A, Los Angeles, CA 90073, US; tel: 310-478-3711 x.49229, fax: 310-268-4056, e-mail:
| | | | - Shirley M Glynn
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA,Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
| | - Luana R Turner
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Kellie M Smith
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Sharon S Mitchell
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Catherine A Sugar
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA,Department of Biostatistics, UCLA School of Public Health, Los Angeles, CA
| | - Morris D Bell
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT,Department of Veterans Affairs Rehab R & D, Psychology Service, VA Connecticut Healthcare System, New Haven, CT
| | - Robert P Liberman
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Alex Kopelowicz
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA
| | - Michael F Green
- UCLA Semel Institute for Neuroscience & Human Behavior, David Geffen School of Medicine, Los Angeles, CA,Department of Veterans Affairs VISN 22 Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA
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Choi J, Lysaker PH, Bell MD, Dixon L, Margolies P, Gold M, Golden-Roose E, Thime W, Haber LC, Dewberry MJ, Stevens M, Pearlson GD, Fiszdon JM. Decisional Informatics for Psychosocial Rehabilitation: A Feasibility Pilot on Tailored and Fluid Treatment Algorithms for Serious Mental Illness. J Nerv Ment Dis 2017; 205:867-872. [PMID: 28991149 PMCID: PMC5827965 DOI: 10.1097/nmd.0000000000000747] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study introduces a computerized clinical decision-support tool, the Fluid Outpatient Rehabilitation Treatment (FORT), that incorporates individual and ever-evolving patient needs to guide clinicians in developing and updating treatment decisions in real-time. In this proof-of-concept feasibility pilot, FORT was compared against traditional treatment planning using similar behavioral therapies in 52 adults with severe mental illness attending community-based day treatment. At posttreatment and follow-up, group differences and moderate-to-large effect sizes favoring FORT were detected in social function, work readiness, self-esteem, working memory, processing speed, and mental flexibility. Of participants who identified obtaining a General Education Diploma as their goal, 73% in FORT passed the examination compared with 18% in traditional treatment planning. FORT was also associated with higher agency cost-effectiveness and a better average benefit-cost ratio, even when considering diagnosis, baseline symptoms, and education. Although the comparison groups were not completely equivalent, the findings suggest computerized decision support systems that collaborate with human decision-makers to personalize psychiatric rehabilitation and address critical decisions may have a role in improving treatment effectiveness and efficiency.
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Affiliation(s)
- Jimmy Choi
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT, USA
| | - Paul H. Lysaker
- Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Morris D. Bell
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT & Yale University School of Medicine, New Haven, CT, USA
| | - Lisa Dixon
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY
| | - Paul Margolies
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA
- Department of Psychiatry, Columbia University, New York, NY
| | - Matthew Gold
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, USA
| | | | - Warren Thime
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT, USA
| | - Lawrence C. Haber
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT, USA
| | | | - Michael Stevens
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT, USA
| | - Godfrey D. Pearlson
- The Institute of Living at Hartford Hospital, 200 Retreat Ave, Hartford, CT, USA
| | - Joanna M. Fiszdon
- Psychology Service, VA Connecticut Healthcare System, West Haven, CT & Yale University School of Medicine, New Haven, CT, USA
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Peterson D, Gordon S, Neale J. It can work: Open employment for people with experience of mental illness. Work 2017; 56:443-454. [PMID: 28269806 DOI: 10.3233/wor-172510] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Previous research has tended to focus on the barriers to employment for people with mental illness and the extra support they may need. This research contributes to the knowledge base pertaining to this population by looking at successful employment relationships in New Zealand. OBJECTIVE To describe factors enabling and/or sustaining the open employment of people with experience of mental illness. METHOD Fifteen pairs of employers and employees were interviewed individually but consecutively (using a semi-structured interview schedule) about their perceptions of the critical factors that enabled and sustained the employee's employment. Employee participants were recruited by advertisement, with employers approached through their employees. Transcripts were analysed using a thematic analysis. RESULTS Themes raised in the interviews included the meaning of work, disclosure of mental illness, the benefits of working, special arrangements or accommodations, the work environment and key things employers and employees do to sustain successful employment. CONCLUSION Four critical success factors were identified relating to disclosure, the employment relationship, freedom from discrimination and workplace flexibility.
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Affiliation(s)
- Debbie Peterson
- Suicide and Mental Health Research Group, University of Otago, Wellington, New Zealand
| | - Sarah Gordon
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - Jenny Neale
- Health Services Research Centre, Victoria University of Wellington, New Zealand
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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Hanisch SE, Wrynne C, Weigl M. Perceived and actual barriers to work for people with mental illness. JOURNAL OF VOCATIONAL REHABILITATION 2017. [DOI: 10.3233/jvr-160839] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sabine E. Hanisch
- Institute for Public Health and Health Services Research, Department of Medical Informatics, Biometry and Epidemiology (IBE), Ludwig Maximilians University, Munich, Germany
| | - Claire Wrynne
- Career Management Service, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, UK
| | - Matthias Weigl
- Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, WHO Collaborating Centre for Occupational Health, Clinic of the Ludwig-Maximilians University, Munich, Germany
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Age and Improved Attention Predict Work Attainment in Combined Compensatory Cognitive Training and Supported Employment for People With Severe Mental Illness. J Nerv Ment Dis 2016; 204:869-872. [PMID: 27798543 PMCID: PMC5117813 DOI: 10.1097/nmd.0000000000000604] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The objective of this study was to examine whether cognitive change and age predicted work outcome in the context of supported employment (SE) and compensatory cognitive training (CCT) in severe mental illness. Forty unemployed outpatients receiving SE (7 young [20-35 years], 15 middle-aged [36-50 years], and 18 older [51-66 years] patients) completed cognitive assessments at baseline and after 12 weeks of CCT. Logistic regression analyses showed that improvement in attention/vigilance significantly predicted work attainment (B = 2.35, SE = 1.16, p = 0.043). Young and older participants were more likely to obtain work than middle-aged participants (B = 4.03, SE = 1.43, p = 0.005; B = 2.16, SE = 0.93, p = 0.021, respectively). Improved attention and age group (young and old) were associated with better work outcomes after SE + CCT. Improving attention may be an important target for improving work outcome in severe mental illness. Middle-aged individuals may need additional support to return to work.
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Sveinsdottir V, Tveito TH, Bond GR, Grasdal AL, Lie SA, Reme SE. Protocol for the SEED-trial: Supported Employment and preventing Early Disability. BMC Public Health 2016; 16:579. [PMID: 27422271 PMCID: PMC4947309 DOI: 10.1186/s12889-016-3280-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 07/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early withdrawal or exclusion from the labor market leads to significant personal and societal costs. In Norway, the increasing numbers of young adults receiving disability pension is a growing problem. While a large body of research demonstrates positive effects of Supported Employment (SE) in patients with severe mental illness, no studies have yet investigated the effectiveness of SE in young adults with a range of social and health conditions who are receiving benefits. METHODS/DESIGN The SEED-trial is a randomized controlled trial (RCT) comparing traditional vocational rehabilitation (TVR) to SE in 124 unemployed individuals between the ages of 18-29 who are receiving benefits due to various social- or health-related problems. The primary outcome is labor market participation during the first year after enrollment. Secondary outcomes include physical and mental health, health behaviors, and well-being, collected at baseline, 6, and 12 months. A cost-benefit analysis will also be conducted. DISCUSSION The SEED-trial is the first RCT to compare SE to TVR in this important and vulnerable group, at risk of being excluded from working life at an early age. TRIAL REGISTRATION Clinicaltrials.gov, registration number NCT02375074 . Registered on December 3rd 2014.
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Affiliation(s)
| | | | - Gary R. Bond
- />Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic St., Suite B4-1, Lebanon, NH 03766 USA
| | | | - Stein Atle Lie
- />Department of Clinical Dentistry, University of Bergen, POB 7804, 5020 Bergen, Norway
| | - Silje Endresen Reme
- />Uni Research Health, Uni Research, POB 7810, 5020 Bergen, Norway
- />Department of Psychology, University of Oslo, POB 1094, 0317 Oslo, Norway
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Modini M, Tan L, Brinchmann B, Wang MJ, Killackey E, Glozier N, Mykletun A, Harvey SB. Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence. Br J Psychiatry 2016; 209:14-22. [PMID: 27103678 DOI: 10.1192/bjp.bp.115.165092] [Citation(s) in RCA: 202] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 07/13/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained. AIMS To investigate whether IPS is effective across international settings and in different economic conditions. METHOD A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth. RESULTS The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99-2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years. CONCLUSIONS Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.
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Affiliation(s)
- Matthew Modini
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Leona Tan
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Beate Brinchmann
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Min-Jung Wang
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Eoin Killackey
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Nicholas Glozier
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Arnstein Mykletun
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
| | - Samuel B Harvey
- Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
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Zaprutko T, Kus K, Bilobryvka R, Rakhman L, Göder R, Michalak M, Pogłodziński A, Nowakowska E. Schizophrenia and Employment: Evaluation From Professionals Point of View. Psychiatr Q 2015; 86:569-79. [PMID: 25736799 DOI: 10.1007/s11126-015-9354-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Schizophrenia is a severe and chronic disorder requiring long-lasting and comprehensive treatment. Because of this disorder patients are socially isolated. Consequently, schizophrenia has a significant economic burden both in a group of direct and indirect costs. The aim was to analyse experts' opinions in the field of psychiatry concerning work possibilities among people with schizophrenia and to present the importance of employment for more effective treatment. A worldwide study was conducted between June 2011 and June 2013 using a questionnaire consisting of six open-closed questions and a short metrics. The questionnaire was delivered to experts and spread all over the world by post and via the internet. Over 3000 questionnaires were sent and the addressed specialists were requested to return them. From received 403 questionnaires 320 were included into the study, based on adopted inclusion and exclusion criteria. Although patients are afraid of looking for a job, respondents indicated that they crave for employment. The number of people that are able to work during remission of schizophrenia is considerably higher (50.35 %) than the number of actually employed (15.85 %). Non-pharmacological therapies were indicated as important to improve patients' chances of finding a job during remission of schizophrenia. The number of people that can work during remission of schizophrenia is considerably higher than the number of affected people employed. Patients crave for a job and supported employment should be treated as priority by health-care decision makers.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland.
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland
| | - Rostyslav Bilobryvka
- Department of Psychiatry, Psychology and Sexology, Lviv National Medical University, 95 Kulparkivska Street, 79021, Lviv, Ukraine
| | - Lyudmyla Rakhman
- Department of Psychiatry, Psychology and Sexology, Lviv National Medical University, 95 Kulparkivska Street, 79021, Lviv, Ukraine
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, 147 Niemannsweg Street, 24105, Kiel, Germany
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland
| | - Andrzej Pogłodziński
- Department of Adult Psychiatry, Poznan University of Medical Sciences, 27 Szpitalna Street, 60572, Poznań, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland
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Cohen CI, Meesters PD, Zhao J. New perspectives on schizophrenia in later life: implications for treatment, policy, and research. Lancet Psychiatry 2015; 2:340-50. [PMID: 26360087 DOI: 10.1016/s2215-0366(15)00003-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/06/2015] [Indexed: 11/17/2022]
Abstract
Worldwide, in the past few decades, the demographics of older people (ie, people 55 years and over) with schizophrenia have changed completely with respect to absolute numbers of people affected, the proportion of all people with the disorder, life expectancy, and residential status. The ageing schizophrenia population has created vast health-care needs and their medical comorbidity contributes to higher mortality than in the general population. Proposals to classify schizophrenia into early-onset, late-onset, and very-late-onset subtypes now should be tempered by the recognition that comorbid medical and neurological disorders can contribute to psychotic symptoms in later life. The concept of outcome has become more nuanced with an appreciation that various outcomes can occur, largely independent of each other, that need different treatment approaches. Data show that schizophrenia in later life is not a stable end-state but one of fluctuation in symptoms and level of functioning, and show that pathways to improvement and recovery exist. Several novel non-pharmacological treatment strategies have been devised that can augment the clinical options used to address the specific needs of older adults with schizophrenia.
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Affiliation(s)
- Carl I Cohen
- SUNY Downstate Medical Center, Brooklyn, NY, USA.
| | - Paul D Meesters
- Department of Psychiatry, VU University Medical Center, GGZ inGeest and EMGO+, Institute for Health and Care Research, Amsterdam, Netherlands
| | - Jingna Zhao
- SUNY Downstate Medical Center, Brooklyn, NY, USA
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Solar A. A Supported Employment linkage intervention for people with schizophrenia who want to work: a survey of patients' views. Australas Psychiatry 2015; 23:163-5. [PMID: 25653303 DOI: 10.1177/1039856214568217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Take into account patient views in developing a linkage intervention to the evidence-based Individual Placement and Support approach to Supported Employment (SE) for patients with schizophrenia on a mental health unit (MHU) who want to work in competitive employment. METHODS Analysis of 20 once-off, face-to-face interviews, with informed consent, between author and voluntary MHU inpatients with schizophrenia about getting into SE from the MHU. RESULTS From the major category 'patient ideas about SE linkage intervention from MHU' the three themes of 'patient choice', 'type of support' and 'start from the MHU' emerged. The other major category, 'patient attitude to the author's proposed SE linkage intervention', revealed the theme of 'positive attitude'. CONCLUSIONS There may be enough interest from patients with schizophrenia on a MHU who want to work, to test a pilot of the author's proposed voluntary SE linkage intervention.
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Affiliation(s)
- Ann Solar
- Consultant Psychiatrist, Department of Psychiatry, Sir Charles Gairdner Hospital, Perth, WA, and; Clinical Senior Lecturer, School of Psychiatry and Clinical Neurosciences, University of Western Australia, Nedlands, WA, Australia
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Abstract
Services are available to help support existing employment for individuals with psychiatric disabilities; however, there is a gap in services targeting job interview skills that can help obtain employment. We assessed the feasibility and efficacy of Virtual Reality Job Interview Training (VR-JIT) in a randomized controlled trial. Participants were randomized to VR-JIT (n = 25) or treatment-as-usual (TAU) (n = 12) groups. VR-JIT consisted of 10 hours of simulated job interviews with a virtual character and didactic online training. The participants attended 95% of laboratory-based training sessions and found VR-JIT easy to use and felt prepared for future interviews. The VR-JIT group improved their job interview role-play performance (p ≤ 0.05) and self-confidence (p ≤ 0.05) between baseline and follow-up as compared with the TAU group. VR-JIT performance scores increased over time (R = 0.65). VR-JIT demonstrated initial feasibility and efficacy at improving job interview skills and self-confidence. Future research may help clarify whether this intervention is efficacious in community-based settings.
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Perez VB, Swerdlow NR, Braff DL, Näätänen R, Light GA. Using biomarkers to inform diagnosis, guide treatments and track response to interventions in psychotic illnesses. Biomark Med 2014; 8:9-14. [PMID: 24325220 DOI: 10.2217/bmm.13.133] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Veronica B Perez
- VISN-22 Mental Illness Research, Education & Clinical Center (MIRECC), VA San Diego Healthcare System, CA 92161, USA and Department of Psychiatry, University of California San Diego, La Jolla, CA, USA
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Solar A. A supported employment linkage intervention for people with schizophrenia who want a chance to work. Australas Psychiatry 2014; 22:245-247. [PMID: 24811717 DOI: 10.1177/1039856214531837] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Investigate feasibility and development of a linkage intervention to the evidence-based Individual Placement and Support (IPS) approach to supported employment (SE) for patients with schizophrenia on a mental health unit who want to work in competitive employment. METHOD Literature review about the evidence-based IPS approach to SE in schizophrenia and why it might not be implemented in mental health services. Analysis of 10 adult mental health unit multidisciplinary staff interviews for categories in the literature review of IPS implementation barriers and whether these barriers could be overcome. RESULTS There was lack of full staff knowledge of the IPS approach to SE. However, all staff knew respect for patient choice was paramount, community employment programs existed for the disabled, an outreach linkage process to such a program and ongoing support for people with schizophrenia would be required. There was staff ambivalence about SE for patients with schizophrenia. CONCLUSION Despite staff ambivalence about SE for people with schizophrenia there was still enough staff knowledge and openness to shape an IPS linkage intervention from a staff perspective.
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Affiliation(s)
- Ann Solar
- Consultant Psychiatrist, Department of Psychiatry, Sir Charles Gairdner Hospital, Clinical Senior Lecturer, School of Psychiatry and Clinical Neurosciences, University of Western Australia, and Sir Charles Gairdner Hospital, WA, Australia
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Salokangas RKR, Heinimaa M, From T, Löyttyniemi E, Ilonen T, Luutonen S, Hietala J, Svirskis T, von Reventlow HG, Juckel G, Linszen D, Dingemans P, Birchwood M, Patterson P, Schultze-Lutter F, Ruhrmann S, Klosterkötter J. Short-term functional outcome and premorbid adjustment in clinical high-risk patients. Results of the EPOS project. Eur Psychiatry 2013; 29:371-80. [PMID: 24315804 DOI: 10.1016/j.eurpsy.2013.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Revised: 09/24/2013] [Accepted: 10/07/2013] [Indexed: 11/16/2022] Open
Abstract
PURPOSE In patients with schizophrenia, premorbid psychosocial adjustment is an important predictor of functional outcome. We studied functional outcome in young clinical high-risk (CHR) patients and how this was predicted by their childhood to adolescence premorbid adjustment. METHODS In all, 245 young help-seeking CHR patients were assessed with the Premorbid Adjustment Scale, the Structured Interview for Prodromal Syndromes (SIPS) and the Schizophrenia Proneness Instrument (SPI-A). The SIPS assesses positive, negative, disorganised, general symptoms, and the Global Assessment of Functioning (GAF), the SPI-A self-experienced basic symptoms; they were carried out at baseline, at 9-month and 18-month follow-up. Transitions to psychosis were identified. In the hierarchical linear model, associations between premorbid adjustment, background data, symptoms, transitions to psychosis and GAF scores were analysed. RESULTS During the 18-month follow-up, GAF scores improved significantly, and the proportion of patients with poor functioning decreased from 74% to 37%. Poor premorbid adjustment, single marital status, poor work status, and symptoms were associated with low baseline GAF scores. Low GAF scores were predicted by poor premorbid adjustment, negative, positive and basic symptoms, and poor baseline work status. The association between premorbid adjustment and follow-up GAF scores remained significant, even when baseline GAF and transition to psychosis were included in the model. CONCLUSION A great majority of help-seeking CHR patients suffer from deficits in their functioning. In CHR patients, premorbid psychosocial adjustment, baseline positive, negative, basic symptoms and poor working/schooling situation predict poor short-term functional outcome. These aspects should be taken into account when acute intervention and long-term rehabilitation for improving outcome in CHR patients are carried out.
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Affiliation(s)
- R K R Salokangas
- Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland.
| | - M Heinimaa
- Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland
| | - T From
- Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland
| | - E Löyttyniemi
- Department of Biostatistics, University of Turku, Turku, Finland
| | - T Ilonen
- Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland
| | - S Luutonen
- Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland
| | - J Hietala
- Department of Psychiatry, University of Turku, 70, Kunnallissairaalantie, 20700 Turku, Finland; Psychiatric Clinic, Turku University Central Hospital, Turku, Finland; Turku Psychiatric Clinic, Turku Mental Health Centre, Turku, Finland
| | - T Svirskis
- Department of Psychiatry, University of Helsinki, Helsinki, Finland; Peijas Hospital, Helsinki University Central Hospital, Helsinki, Finland
| | - H G von Reventlow
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany
| | - G Juckel
- Department of Psychiatry, Ruhr-University Bochum, LWL University Hospital, Bochum, Germany
| | - D Linszen
- Department of Psychiatry and Psychology, University of Maastricht, Maastricht, Netherlands
| | | | - M Birchwood
- School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - P Patterson
- Youthspace - Birmingham & Solihull Mental Health Foundation Trust, Birmingham, United Kingdom
| | - F Schultze-Lutter
- University Hospital of Child and Adolescent Psychiatry, University of Bern, Bern, Switzerland
| | - S Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - J Klosterkötter
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
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Making the Case for IPS Supported Employment. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2012; 41:69-73. [DOI: 10.1007/s10488-012-0444-6] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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