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Fleury MJ, Cao Z, Grenier G, Ferland F. Profiles of quality of life among patients using emergency departments for mental health reasons. Health Qual Life Outcomes 2023; 21:116. [PMID: 37880748 PMCID: PMC10601205 DOI: 10.1186/s12955-023-02200-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 10/11/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use. METHODS Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them. RESULTS Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions. CONCLUSION The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.
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Affiliation(s)
- Marie-Josée Fleury
- Department of Psychiatry, McGill University, Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada.
- Douglas Hospital Research Centre, 6875 LaSalle Blvd, Montreal, QC, H4H 1R3, Canada.
| | - Zhirong Cao
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Guy Grenier
- Douglas Mental Health University Institute Research Centre Montreal, Montreal, QC, Canada
| | - Francine Ferland
- School of Social Work, Addiction Rehabilitation Center, Laval University, National Capital University Integrated Health and Social Services Center, Quebec City, QC, Canada
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Drake RE, Bond GR. Individual placement and support: History, current status, and future directions. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2023; 2:e122. [PMID: 38867819 PMCID: PMC11114326 DOI: 10.1002/pcn5.122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 06/06/2023] [Accepted: 06/28/2023] [Indexed: 06/14/2024]
Abstract
Over the past three decades, Individual Placement and Support (IPS) has emerged as a robust evidence-based approach to helping people with severe mental illnesses, such as schizophrenia, bipolar disorder, and major depression, to obtain and succeed in competitive employment. This review addresses the history, principles, research, and future directions of IPS. It covers current evidence on employment outcomes, cost-effectiveness, and nonvocational outcomes. It also describes current attempts to extend IPS to new populations. The authors provide an overview of numerous systematic reviews and meta-analyses of randomized controlled trials involving people with serious mental illness. For studies addressing nonvocational outcomes and new populations, the review uses best available evidence. Published reviews agree that IPS enables patients with serious mental illness in high-income countries to succeed in competitive employment at a higher rate than patients who receive other vocational interventions. Within IPS programs, quality of implementation, measured by standardized fidelity scales, correlates with better outcomes. Employment itself leads to enhanced income, psychosocial outcomes, clinical improvements, and decreased mental health service use. As IPS steadily spreads to new populations and new settings, research is active across high-income countries and spreading slowly to middle-income countries. IPS is an evidence-based practice for people with serious mental illness in high-income countries. It shows promise to help other disability groups also, and emerging research aims to clarify adaptations and outcomes.
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Affiliation(s)
- Robert E. Drake
- Department of PsychiatryColumbia University Vagelos College of Physicians and SurgeonsNew York CityNew YorkUSA
- Westat CorporationRockvilleMarylandUSA
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3
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Sprong ME, Hollender H, Lee YS, Rawlins Williams LA, Sneed Z, Garakani A, Buono FD. Disparities in program enrollment and employment outcomes for veterans with psychiatric and co-occurring substance use disorders referred or enrolled for VHA vocational rehabilitation. Front Psychiatry 2023; 14:1200450. [PMID: 37520235 PMCID: PMC10382058 DOI: 10.3389/fpsyt.2023.1200450] [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] [Received: 04/18/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction The purpose of the study was to investigate factors that influence vocational rehabilitation program enrollment and employment at discharge of veterans with psychiatric and co-occurring alcohol and other substance use disorders enrolled at a veteran health administration (VHA) medical center. Methods A sample of 2,550 veteran patients referred for VHA vocational rehabilitation between 2016 and 2021 were examined for the current study. The current study was classified as quality improvement/assurance, thus resulting in exempt research by the U.S. Department of Veteran Affairs Institutional Review Board. Results Veterans with active alcohol use disorders (AUDs) and co-occurring depression, anxiety, post-traumatic stress disorder, or bipolar disorders were less likely to be enrolled for vocational rehabilitation program services compared to those without these co-occurring diagnoses. Veterans with AUD (active & in-remission status combined into one category) and a diagnosis of anxiety were less likely to be employed at discharge compared to veterans with AUDs and no anxiety diagnosis (anxiety diagnosis - 3.5% vs. no anxiety diagnosis - 5.8%). Discussion VHA vocational rehabilitation can be an effective intervention to assist veterans in reintegrating back into the community. Yet, there appears to be some disparities in the program enrollment and employment at discharge, depending on the nature of the psychiatric diagnosis. Investigating the factors contributing (mediating or moderating) to these discrepancies are needed. Although it appears access is not the issue in being referred for vocational rehabilitation services, other factors are likely contributing to program entry.
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Affiliation(s)
- Matthew E. Sprong
- Edward Hines Jr. VA Medical Center, Hines, IL, United States
- School of Public Management and Policy, University of Illinois Springfield, Springfield, IL, United States
| | - Heaven Hollender
- Department of Health Sciences, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| | - Yu-Sheng Lee
- School of Integrated Sciences, Sustainability, and Public Health, University of Illinois Springfield, Springfield, IL, United States
| | - Lee Ann Rawlins Williams
- Rehabilitation and Human Services, College of Education and Human Development, University of North Dakota, Grand Forks, ND, United States
| | - Zach Sneed
- School of Health Professions, Texas Tech University Health Sciences Center, Lubbock, TX, United States
| | - Amir Garakani
- Department of Psychiatry and Behavioral Health, Greenwich Hospital, Greenwich, CT, United States
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
| | - Frank D. Buono
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, United States
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4
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Jäckel D, Willert A, Brose A, Leopold K, Nischk D, Senner S, Pogarell O, Sachenbacher S, Lambert M, Rohenkohl A, Kling-Lourenco P, Rüsch N, Bermpohl F, Schouler-Ocak M, Disselhoff V, Skorupa U, Bechdolf A. Enhancing educational and vocational recovery in adolescents and young adults with early psychosis through Supported Employment and Education (SEEearly): study protocol for a multicenter randomized controlled trial. Trials 2023; 24:440. [PMID: 37400899 PMCID: PMC10316586 DOI: 10.1186/s13063-023-07462-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 06/13/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Psychotic disorders often develop a chronic course with devastating consequences for individuals, families, and societies. Early intervention programs for people in the first 5 years after the initial psychotic episode (early psychosis) can significantly improve the outcome and are therefore strongly recommended in national and international guidelines. However, most early intervention programs still focus on improving symptoms and relapse prevention, rather than targeting educational and vocational recovery. The aim of the present study is to explore the effects of Supported Employment and Education (SEE) following the Individual Placement and Support (IPS) model in people with early psychosis. METHODS The SEEearly trial compares treatment as usual (TAU) plus SEE to TAU alone in outpatient psychiatric settings. The study is a six-site, two-arm, single-blinded, superiority randomized controlled trial (RCT). Participants are randomly assigned (1:1) to the intervention or control group. Aiming to recruit 184 participants, with an assumed drop-out rate of 22%, we will be able to detect a 24% difference in the main outcome of employment/education with 90% power. We make assessments at baseline and at 6- and 12-month follow-ups. Outcome data on employment/education, medication, and current psychiatric treatment is obtained monthly through phone based short assessments. The primary outcome is steady participation for at least 50% of the 12-month follow-up in competitive employment and/or mainstream education. Secondary employment outcomes capture length of employment/education, time to first employment/education, monthly wages/educational attainment, and social return on investment (SROI). Secondary non-employment outcomes include subjective quality of life, psychopathology, substance use, relapse, hospitalization, and functional impairment. To be eligible, participants must be between 16 and 35 years, fulfill diagnostic criteria for early psychosis, and be interested in competitive employment and/or mainstream education. DISCUSSION In SEEearly, we hypothesize that participants with psychosis, who receive TAU plus SEE, present with better primary and secondary outcomes than participants, who receive TAU alone. Positive results of this study will justify SEE as an evidence-based strategy for clinical routine treatment in people with early psychosis. TRIAL REGISTRATION SEEearly was registered nationally and internationally in the German Clinical Trials Register (DRKS; identifier: DRKS00029660) on October 14, 2022.
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Affiliation(s)
- D Jäckel
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - A Willert
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany.
| | - A Brose
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - K Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - D Nischk
- Department of Social Psychiatry, Zentrum für Psychiatrie, Reichenau, Germany
| | - S Senner
- Department of Social Psychiatry, Zentrum für Psychiatrie, Reichenau, Germany
| | - O Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - S Sachenbacher
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - M Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Rohenkohl
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Kling-Lourenco
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - N Rüsch
- Department of Psychiatry II, University of Ulm and BKH Günzburg, Ulm, Germany
| | - F Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - M Schouler-Ocak
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Psychiatric University Clinic of Charité at St. Hedwig Hospital, Berlin, Germany
| | - V Disselhoff
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - U Skorupa
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - A Bechdolf
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Klinikum am Urban and Vivantes Klinikum im Friedrichshain, Berlin, Germany
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5
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Thongsalab J, Yunibhand J, Uthis P. Recovery-oriented nursing service for people with schizophrenia in the community: An integrative review. BELITUNG NURSING JOURNAL 2023; 9:198-208. [PMID: 37492751 PMCID: PMC10363967 DOI: 10.33546/bnj.2632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/12/2023] [Accepted: 05/22/2023] [Indexed: 07/27/2023] Open
Abstract
Background The recovery-oriented service concept has been recognized for its impact on mental health practices and services. As the largest group of mental healthcare providers, mental health nurses are well-positioned to deliver recovery-oriented services but face challenges due to role ambiguity and identity issues. Therefore, clarifying the role and principles of mental health nursing is essential. Objective This study aimed to identify essential nursing practices for individuals with schizophrenia in recovery-oriented mental health services. Design The study utilized a five-step integrative review approach, including problem identification, literature search definition, critical analysis of methodological quality, data analysis, and data presentation. Data Sources Multiple databases, such as ScienceDirect and Scopus, as well as online libraries and journals/publishers, including Sage journals, APA PsyNet, SpringerLink, PsychiatryOnline, Taylor & Francis Online, and Wiley Online Library, were searched. The search spanned from the inception of the recovery-oriented services concept in 1993 to 2022. Review Methods Content and thematic analysis were employed to analyze and synthesize the findings from the included studies. Results Twenty-four articles met the inclusion criteria. Two themes were identified: 1) Direct nursing care, consisting of six sub-themes: therapeutic nurse-patient relationship (TNPR), psychoeducation (PE), coping skill training (CST), cognitive behavioral techniques (CBT), interventions to improve medication adherence (IMA), and social functioning (SF); and 2) Indirect nursing care. Conclusion This study highlights the crucial role of nursing and nursing practices in recovery-oriented services. Mental health nurses prioritize person-centered care, therapeutic relationships, and collaboration with peer support workers to enhance treatment effectiveness. In addition, they focus on improving medication adherence, providing coping support, and promoting social capabilities, ultimately improving individuals' quality of life. Aligning actions with recovery-oriented principles, mental health nurses emphasize empowerment and holistic care. Further research in this area will enhance the healthcare system and better support individuals on their recovery journey.
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Affiliation(s)
| | | | - Penpaktr Uthis
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand
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Khalid A, Syed J. A relational perspective of schizophrenia at work. EQUALITY, DIVERSITY AND INCLUSION: AN INTERNATIONAL JOURNAL 2023. [DOI: 10.1108/edi-06-2022-0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
PurposeDespite a plethora of research on diversity and inclusion, workplace-related issues pertaining to individuals with schizophrenia (SCZ) remain grossly underexplored. This paper seeks to develop a relational, multilevel perspective of issues and challenges faced by individuals with SCZ in the work and career.Design/methodology/approachThe research draws on the findings from in-depth, qualitative interviews with schizophrenic individuals, individuals’ family members, healthcare professionals and nongovernmental organization (NGO) representatives.FindingsThe findings highlight the interconnected nature of multilevel issues faced by schizophrenic individuals and indicate that at the societal level, social stigma, economic conditions and inadequate government policies are the key challenges faced by them. At the organizational level workplace support and job suitability and design affect individuals’ employment. At the individual level, self-stigma affects the employability in a negative way whereas personal motivation and resilience, family and social support and realization of illness are the facilitating factors.Originality/valueThe study adds to disability and diversity literature by developing a relational perspective that holistically captures the issues faced by schizophrenic individuals and suggests that the work and employment-related issues may be simultaneously addressed at multiple levels.
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7
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Butenko D, Rinaldi M, Brinchmann B, Brandseth OL, Killackey E, Mykletun A. The personality profile of IPS employment specialists, and how it relates to job satisfaction: A longitudinal cohort study. Scand J Psychol 2023; 64:71-79. [PMID: 35997312 PMCID: PMC10087514 DOI: 10.1111/sjop.12864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 07/03/2022] [Accepted: 08/01/2022] [Indexed: 01/11/2023]
Abstract
The role of the Individual Placement and Support (IPS) employment specialist is a new type of occupation within mental healthcare. High turnover among employment specialists necessitates improvement in their recruitment and retention. One element that impacts retention is job satisfaction. We assessed the personality of 38 employment specialists (Big 5 Inventory-2) and measured job satisfaction over three time periods. Compared to norm data, employment specialists were significantly higher on Extraversion (ΔT = 8.0, CI: 5.59-10.42), Agreeableness (ΔT = 7.8, CI: 5.56-10.12), Conscientiousness (ΔT = 3.3, CI: 0.8-5.84), Open-mindedness (ΔT = 3.5, CI: 0.97-6.07), while lower on Negative emotionality (ΔT = -3.5, CI: -6.5 to -0.42). Extraversion had a substantial longitudinal positive effect on job satisfaction (β at T1 = 0.39; CI: 0.10-0.73) (β at T2 = 0.40; CI: 0.03-0.80), while Negative emotionality - a substantial negative effect (β at T1 = -0.60; CI: -0.90 to -0.30) (β at T2 = -0.50; CI: -0.90 to -0.12). Male gender was significantly associated with higher job satisfaction at the time point 1 (β = -0.46; CI: -0.80 to -0.14). Age, length of employment in the role, Agreeableness, Conscientiousness and Open-mindedness were not found to have substantial significant effects on job satisfaction of employment specialists. Recruiting employment specialists who score high on Extraversion and low on Negative emotionality may be a good fit for the role and job satisfaction.
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Affiliation(s)
- Daniil Butenko
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University in Bergen, Bergen, Norway
| | - Miles Rinaldi
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,South West London and St George's Mental Health NHS Trust, London, UK
| | - Beate Brinchmann
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,UiT The Arctic University of Norway, Tromsø, Norway
| | - Oda Lekve Brandseth
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Eoin Killackey
- Orygen, Parkville, Victoria, Australia.,Centre for Youth Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Arnstein Mykletun
- Centre for work and mental health, Nordland Hospital trust, Bodø, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway.,UiT The Arctic University of Norway, Tromsø, Norway.,Norwegian Institute of Public Health, Oslo, Norway
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Accelerating integration of social needs into mainstream healthcare to achieve health equity in the COVID-19 era. HEALTH ECONOMICS, POLICY, AND LAW 2023; 18:82-87. [PMID: 35912976 DOI: 10.1017/s1744133122000172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
It is known that social inequities result in health disparities in outcomes, highlighted in the coronavirus disease 2019 (COVID-19) pandemic. This commentary discusses the actionable initiatives that have been implemented to address social inequities in healthcare in the United States. The publicly available social needs screening tools and International Classification of Disease Systems-10 Z codes for social determinants of health are introduced. In this context, policies, health system strategies and the larger role of implementation science in recognizing and alleviating the social needs are discussed.
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Kheir S, Lipskaya-Velkovsky L. The Arab minority of East Jerusalem: An exploratory study of vocational rehabilitation in mental health. Work 2023; 75:1379-1392. [PMID: 36776090 DOI: 10.3233/wor-220266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
BACKGROUND The Arab population of East Jerusalem with serious mental illness (SMI) is an ethnic and health status minority that has unique employment issues. Vocational rehabilitation offered to this population is guided by standard regulations that are grounded in knowledge obtained from Western communities on the employment enablers, while negligible research was done to investigate relevance of these enablers for the Arab population. OBJECTIVE The study aims to examine the previously well-established association between motor, cognitive, and emotional personal factors, occupation features, environmental characteristics, and vocational outcomes of job satisfaction and performance among the Arab population of East Jerusalem with SMI. METHODS Twenty-three men and women, aged 23-58, from this minority group who had received vocational rehabilitation participated in this cross-sectional study. They completed standard assessments of motor and cognitive skills, self-efficacy, work-environment suitability, and job satisfaction. Employers then rated their level of functioning at work. RESULTS No correlation was found between the outcome measurements and most of the personal factors and environmental characteristics (p > 0.05), except for an association between job satisfaction, work self-efficacy, and work control. No expected differences were found between vocational rehabilitation programs in the variables of interest (p > 0.05). CONCLUSION The disparity from well-established patterns of association between enablers and employment outcomes reveals unique characteristics of the investigated population and suggests the impact cultural issues has on vocational rehabilitation. The findings raise an urgent call for an in-depth investigation of the complex phenomenon of employment in this population to support sustainable employment benefits and recovery journey.
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Affiliation(s)
- Samah Kheir
- Mental Health Rehabilitation Department of Jerusalem District, Ministry of Health, Jerusalem, Israel
- School of Health Profession, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lena Lipskaya-Velkovsky
- School of Occupational Therapy, Faculty of Medicine, The Hebrew University, Jerusalem, Israel
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10
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Bujanover M, Mashiach-Eizenberg M, Moran GS. Meaning in life and flow experiences among people with psychiatric disabilities who are engaged in peer-helping vs. non-helping work-roles. JOURNAL OF VOCATIONAL REHABILITATION 2022. [DOI: 10.3233/jvr-221217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Finding meaning in life and wellbeing through vocational work-roles are central to recovery of persons with psychiatric disabilities. However, there is a disconnect between positive concepts and vocational rehabilitation, rendering meaning and wellbeing rarely explored in vocational rehabilitation. OBJECTIVE: We assume higher meaning and wellbeing exists among individuals engaged in peer helping work-roles (meaningful role) as compared to non-helping work-roles. We examine this and additional questions to learn about relationships between positive concepts and vocational work-roles illuminating mental health recovery. METHODS: 114 individuals with psychiatric disabilities (ages 20-70) from various vocational-services participated. Sixty-nine worked in peer-helping roles (i.e. consumer-providers/peer-supporters) and 45 engaged in non-helping work-roles (vendors/clerical work, etc.). Participants filled in the Meaning in Life and Work-related Flow (assessing wellbeing at work) scales. Additionally, participants in peer-helping work-roles filled a peer-developed scale estimating their salience of peer-role characteristics. RESULTS: Individuals in peer-helping work-roles had significantly higher meaning in life levels than those in non-helping roles. Having meaning in life also predicted higher work-related flow across the sample. Finally, meaning in life positively mediated relations between salience of peer-role characteristics and work-related flow experiences. CONCLUSION: Researching meaning and wellbeing can broaden theoretical understanding and bear practical implications for enhancing vocational work-role fit and recovery.
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Affiliation(s)
- May Bujanover
- Department of Social Work, Ben-Gurion University, Beer Sheba, Israel
| | | | - Galia S. Moran
- Department of Social Work, Ben-Gurion University, Beer Sheba, Israel
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Effectiveness of personal recovery facilitators in adults with schizophrenia and other psychoses: A systematic review of reviews and narrative synthesis. Schizophr Res 2022; 246:132-147. [PMID: 35777151 DOI: 10.1016/j.schres.2022.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 06/14/2022] [Accepted: 06/19/2022] [Indexed: 01/12/2023]
Abstract
This review aimed to examine the evidence base for the use of personal recovery facilitators [non-psychopharmacological approaches] for adults with a diagnosis of schizophrenia and other psychoses. A systematic review (umbrella review) was conducted of reviews published in English between January 2010 and February 2022, which examined the effectiveness of personal recovery facilitators to support aspects of personal recovery as defined by the CHIME framework (connectedness, hope and optimism, identity, meaning and purpose, and empowerment). Twenty-one systematic reviews on thirteen different types of personal recovery facilitators [PRFs] were included in this umbrella review. Only one review sought to directly measure personal recovery processes according to the CHIME framework. Outcome measures mostly aligned with the processes of hope (21 reviews) and connectedness (19 reviews). Those related to empowerment (2 reviews), identity (5 reviews) and meaning and purpose (1 review) were less frequently the focus of PRFs. Yoga and music therapy showed the most promise as PRFs. Vocational treatments and integrated supported employment show good potential as personal recovery facilitators. However, together with narrative photovoice, art making and exhibition, they require further robust research to fully examine their impact. Personal recovery is only beginning to be considered as an intended outcome of interventions for persons with schizophrenia and other psychoses. This may be due in part to the continued predominance of the biomedical model approach to recovery within statutory services. Future evaluations of PRFs should include outcome measures that directly assess personal recovery according to the CHIME framework or other measures developed in consultation with recipients of these approaches. Review registration number and date: PROSPERO 2020 CRD42020215471: 10/11/20.
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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: 12] [Impact Index Per Article: 6.0] [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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13
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Kim M, Byrne AM, Jeon J. The Effect of Vocational Counseling Interventions for Adults with Substance Use Disorders: A Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4674. [PMID: 35457542 PMCID: PMC9027488 DOI: 10.3390/ijerph19084674] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 02/04/2023]
Abstract
The authors reviewed the research literature evaluating the effectiveness of vocational counseling interventions focused on employment for consumers with substance use disorders. This review included 11 articles related to vocational counseling interventions, which are either incorporated with substance use treatment or not. The results of this review revealed that vocational counseling services have been highly efficacious in resulting in part-time and full-time jobs. The study designs had some limitations, and few studies employed randomized control trials (RCT).
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Affiliation(s)
- Min Kim
- Department of Social Welfare, Incheon National University, Incheon 22012, Korea;
| | - Andrew M. Byrne
- School of Education, California Polytechnic State University, San Luis Obispo, CA 93407, USA;
| | - Jihye Jeon
- Department of Social Welfare, Incheon National University, Incheon 22012, Korea;
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14
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Gühne U, Pabst A, Kösters M, Hasan A, Falkai P, Kilian R, Allgöwer A, Ajayi K, Baumgärtner J, Brieger P, Frasch K, Heres S, Jäger M, Küthmann A, Putzhammer A, Schneeweiß B, Schwarz M, Becker T, Breilmann J, Riedel-Heller SG. Predictors of competitive employment in individuals with severe mental illness: results from an observational, cross-sectional study in Germany. J Occup Med Toxicol 2022; 17:3. [PMID: 35042511 PMCID: PMC8767732 DOI: 10.1186/s12995-022-00345-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 01/03/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Employment is of great importance as it is associated with various positive effects. Individuals with severe mental illness (SMI) are often excluded from competitive employment. Current data on employment of individuals with mental illness are rare, and influencing factors are under-researched. The present study examines possible predictors of competitive employment among individuals with SMI. METHODS This was a cross-sectional and multicentered study of 300 individuals with SMI aged 18 to 65 years. The following inclusion criteria were used: (I) diagnosis of schizophrenia, schizotypal and delusional disorders (ICD-10 F2x), or affective disorders (ICD-10 F3x), (II) duration of psychiatric illness ≥ 2 years, and (III) substantial impact of illness on social functioning. Participants were interviewed by trained staff using standardised instruments. The relationship between potential predictors (age, sex, education, marital status, living situation, migration background, psychosocial functioning, age at first mental problem, physical illness, work ability) and employment was analysed using a hierarchic binary logistic regression model. RESULTS Only one-third (34%) of participants were competitively employed. Almost one-third were unemployed (30%), and 28% reported early retirement due to mental illness. Psychosocial functioning was positively associated with competitive employment (OR = 1.09, 95% CI: 1.05 - 1.13, p < 0.001); concurrent chronic physical illness was negatively associated with competitive employment (OR = 0.38, 95% CI: 0.21 - 0.71, p = 0.002). CONCLUSIONS Findings confirm a high risk of exclusion from competitive employment among individuals with SMI. Nonetheless, a substantial proportion of individuals are employed. Findings call for efforts to maintain or enhance workforce participation among individuals with SMI. A special focus should be placed on improving physical health and strengthening psychosocial functioning. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register (DRKS) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019).
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Affiliation(s)
- Uta Gühne
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
| | - Markus Kösters
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital Munich, Munich, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Andreas Allgöwer
- Institute for Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
| | | | - Jessica Baumgärtner
- Department of Psychiatry, Psychotherapy and Psychosomatic, University of Augsburg, Medical Faculty, BKH Augsburg, Augsburg, Germany
| | | | - Karel Frasch
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Donauwörth, Donauwörth, Germany
| | | | - Markus Jäger
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
- Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Kempten, Kempten, Germany
| | - Andreas Küthmann
- Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Memmingen, Memmingen, Germany
| | - Albert Putzhammer
- Department of Psychiatry, Psychotherapy and Psychosomatic, District hospital Kaufbeuren, Kaufbeuren, Germany
| | | | | | - Thomas Becker
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Johanna Breilmann
- Department of Psychiatry and Psychotherapy II, Ulm University, BKH Günzburg, Günzburg, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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15
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Pai N, Dark F, Castle D. The Importance of Employment for Recovery, in People with Severe Mental Illness. ACTA ACUST UNITED AC 2021; 8:217-219. [PMID: 34660177 PMCID: PMC8510884 DOI: 10.1007/s40737-021-00245-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/04/2021] [Indexed: 11/21/2022]
Affiliation(s)
- Nagesh Pai
- Graduate Medicine, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, NSW Australia.,Illawarra Health and Medical Research Institute, Wollongong, NSW Australia.,Illawarra Shoalhaven Local Health District, Wollongong, NSW Australia
| | - Frances Dark
- Princess Alexandra Mental Health Service, Princess Alexandra Hospital, Woolloongabba, QLD Australia.,Queensland Health, Brisbane, QLD Australia
| | - David Castle
- Department of Psychiatry, Centre for Complex Interventions, Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
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16
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McDowell C, Fossey E, Harvey C. Moving clients forward: a grounded theory of disability employment specialists' views and practices. Disabil Rehabil 2021; 44:5504-5512. [PMID: 34190004 DOI: 10.1080/09638288.2021.1937341] [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] [Indexed: 10/21/2022]
Abstract
PURPOSE This study sought to better understand the views and practices of disability employment specialists working with clients with mental illness. Specifically, it explored what helps and hinders employment specialists in their work. MATERIALS AND METHODS A constructivist grounded theory methodology was used. Semi-structured interviews with 16 disability employment specialists from four employment service providers in Victoria, Australia, were transcribed and analysed through initial coding, focused coding, and constant comparative methods. RESULTS Analysis led to the substantive grounded theory of "moving clients forward." The key themes included "taking a firm but fair approach," "meeting clients where they are at," "getting clients ready for work," "managing the interface between clients and employers," and as a consequence, "working under pressure." CONCLUSIONS These findings contribute the first grounded theory of how Australian disability employment specialists work with clients with mental illness and enhance understanding of employment specialists' notions of job readiness and their use of discretion in implementing seemingly contradictory employment-related policies. Practice tensions for these employment specialists could be reduced by modifying disability employment policies, and through training to deliver evidence-based practices that offer varied vocational services, pathways, and adjunct interventions tailored to clients' interests, needs and readiness for change.IMPLICATIONS FOR REHABILITATIONAustralian disability employment specialists experience tensions between meeting the needs of clients with mental illness and feeling pressured to adhere to performance-based funding and disability employment policies.Greater emphasis on evidence-based, individualised vocational interventions would better align with a recovery orientation and offer vocational options tailored to the needs and goals of job seekers with mental illnessFurther training and systemic support is needed for disability employment specialists to adopt evidence-based practices in their work with jobseekers with mental illness.Since Australian disability employment specialists describe considering the "job readiness" of clients in practice, the usefulness of this concept merits further investigation.
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Affiliation(s)
- Caitlin McDowell
- Department of Community and Clinical Allied Health, La Trobe University, Melbourne, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia.,Melbourne Health, NorthWestern Mental Health, Melbourne, Australia.,Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Ellie Fossey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Carol Harvey
- Psychosocial Research Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia.,Living with Disability Research Centre, School of Allied Health, La Trobe University, Melbourne, Australia
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17
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Audhoe SS, Hoving JL, Zijlstra BJH, Frings-Dresen MHW, Nieuwenhuijsen K. Is the "Brainwork Intervention" effective in reducing sick leave for non-permanent workers with psychological problems? Results of a controlled clinical trial. BMC Public Health 2021; 21:698. [PMID: 33836711 PMCID: PMC8034165 DOI: 10.1186/s12889-021-10704-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 03/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Both the presence of psychological problems and the absence of an employment contract are related to long-term sickness absence, prolonged work disability and unemployment. Studies researching the effectiveness of return-to-work interventions on these non-permanent workers, including unemployed and temporary agency workers and workers with an expired fixed-term contract, are lagging behind. Therefore, a return-to-work intervention called “Brainwork” was developed. The aim of this study was to assess the effectiveness of the ‘Brainwork Intervention’ in reducing the duration of sick leave compared to usual care over a 12-month follow-up. Methods In a multicenter controlled clinical trial, using a quasi-randomization procedure, we compared the Brainwork Intervention (n = 164) to usual care (n = 156). The primary outcome was the duration of sick leave. Secondary outcomes were the duration of sick leave starting from Social Security Agency transfer; the proportion of workers returned to work; the number of hours of paid employment during the follow-up period; the degree of worker participation; the level of psychological complaints; and the self-efficacy for return to work. Protocol adherence (Brainwork Intervention) was considered sufficient when at least three of the five protocol steps were followed. Cox regressions, linear and ordinal regression, and Mixed Model analyses were performed. Results All 320 participants were analyzed. The Brainwork Intervention resulted in a non-significant reduction of the duration of sick leave compared to usual care (269 days versus 296 days; HR = 1.29; 95% CI 0.94–1.76; p = 0.11). For those working (46%) during the 12-month follow-up, the mean number of hours of paid employment was non-significantly higher in the usual care group (682 h versus 493 h; p = 0.053). No significant differences were found for other secondary outcomes. Protocol adherence was 10%. Conclusions The Brainwork Intervention as performed with a low protocol adherence did not result in a significant reduction of the duration of sick leave compared to usual care. It remains unclear what the results would have been if the Brainwork Intervention had been executed according to protocol. Trial registration The Netherlands Trial Register (NTR); NTR3976 (old registration number NTR4190). Registered September 27th 2013. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10704-0.
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Affiliation(s)
- Selwin S Audhoe
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health/Research Center for Insurance Medicine, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Jan L Hoving
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health/Research Center for Insurance Medicine, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Bonne J H Zijlstra
- Faculty of Behavioral and Social Sciences, University of Amsterdam, Research Institute of Child Development and Education, Amsterdam, The Netherlands
| | - Monique H W Frings-Dresen
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health/Research Center for Insurance Medicine, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
| | - Karen Nieuwenhuijsen
- Amsterdam UMC, University of Amsterdam, Coronel Institute of Occupational Health/Research Center for Insurance Medicine, Amsterdam Public Health research institute, PO Box 22700, 1100 DE, Amsterdam, The Netherlands.
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18
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Abraham KM, Chang MUM, Van T, Resnick SG, Zivin K. Employment After Vocational Rehabilitation Predicts Decreased Health Care Utilization in Veterans With Mental Health Diagnoses. Mil Med 2021; 186:850-857. [PMID: 33825897 DOI: 10.1093/milmed/usab113] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/20/2021] [Accepted: 03/16/2021] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Although the benefits of employment for veterans with mental health conditions are well-known, the effect of veterans' employment on a health system has not been evaluated. The purpose of this study was to evaluate the effect of veterans' employment (versus unemployment) on subsequent health care utilization in the Veterans Health Administration (VHA). MATERIALS AND METHODS This study used a sample of 29,022 veterans with mental health and substance use disorders who were discharged from VHA's employment services programs between fiscal years 2006 and 2010. Veterans' employment status (employed/unemployed) upon discharge from VHA employment programs was ascertained from program discharge forms and linked with VHA administrative health care utilization data for the subsequent 1- and 5-year periods. RESULTS Multivariable ordinary least-squares and logistic regression models adjusted for site clustering and covariates indicated that employment (versus unemployment) predicted less health care utilization 1 year and 5 years post-discharge from employment services, including fewer outpatient mental health visits, homelessness services visits, employment services visits, primary care visits, and lower odds of mental health hospitalizations, mental health or vocational rehabilitation residential stays, and medical hospitalizations. Employment did not predict emergency department visits. CONCLUSIONS VHA's investment in employment services for veterans with mental health and substance use disorders could reduce health care utilization system wide.
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Affiliation(s)
- Kristen M Abraham
- Serious Mental Illness Treatment Resource and Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, Ann Arbor, MI 48105, USA.,Department of Psychology, University of Detroit Mercy, Detroit, MI 48221, USA
| | - Ming-Un Myron Chang
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Tony Van
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA
| | - Sandra G Resnick
- Northeast Program Evaluation Center, Office of Mental Health and Suicide Prevention, Veterans Health Administration, West Haven, CT 06516, USA.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06511, USA
| | - Kara Zivin
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48105, USA.,Department of Psychiatry, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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19
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Chilman N, Song X, Roberts A, Tolani E, Stewart R, Chui Z, Birnie K, Harber-Aschan L, Gazard B, Chandran D, Sanyal J, Hatch S, Kolliakou A, Das-Munshi J. Text mining occupations from the mental health electronic health record: a natural language processing approach using records from the Clinical Record Interactive Search (CRIS) platform in south London, UK. BMJ Open 2021; 11:e042274. [PMID: 33766838 PMCID: PMC7996661 DOI: 10.1136/bmjopen-2020-042274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/06/2020] [Accepted: 11/10/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES We set out to develop, evaluate and implement a novel application using natural language processing to text mine occupations from the free-text of psychiatric clinical notes. DESIGN Development and validation of a natural language processing application using General Architecture for Text Engineering software to extract occupations from de-identified clinical records. SETTING AND PARTICIPANTS Electronic health records from a large secondary mental healthcare provider in south London, accessed through the Clinical Record Interactive Search platform. The text mining application was run over the free-text fields in the electronic health records of 341 720 patients (all aged ≥16 years). OUTCOMES Precision and recall estimates of the application performance; occupation retrieval using the application compared with structured fields; most common patient occupations; and analysis of key sociodemographic and clinical indicators for occupation recording. RESULTS Using the structured fields alone, only 14% of patients had occupation recorded. By implementing the text mining application in addition to the structured fields, occupations were identified in 57% of patients. The application performed on gold-standard human-annotated clinical text at a precision level of 0.79 and recall level of 0.77. The most common patient occupations recorded were 'student' and 'unemployed'. Patients with more service contact were more likely to have an occupation recorded, as were patients of a male gender, older age and those living in areas of lower deprivation. CONCLUSION This is the first time a natural language processing application has been used to successfully derive patient-level occupations from the free-text of electronic mental health records, performing with good levels of precision and recall, and applied at scale. This may be used to inform clinical studies relating to the broader social determinants of health using electronic health records.
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Affiliation(s)
- Natasha Chilman
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Xingyi Song
- Department of Computer Science, University of Sheffield, Sheffield, UK
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Esther Tolani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Zoe Chui
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Karen Birnie
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- King's College Hospital NHS Trust, London, UK
| | - Lisa Harber-Aschan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Billy Gazard
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - David Chandran
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jyoti Sanyal
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Stephani Hatch
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
| | - Anna Kolliakou
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
- Economic and Social Research Council (ESRC) Centre for Society and Mental Health, King's College London, London, UK
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20
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Frank RG, Glied SAM, Shields M. Jobs for People With Mental Health Conditions: Trends and Prospects. Psychiatr Serv 2021; 72:143-147. [PMID: 32966178 PMCID: PMC7869603 DOI: 10.1176/appi.ps.202000243] [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: 11/30/2022]
Abstract
OBJECTIVE For individuals with serious mental illness, work can play an important role in improving quality of life and community integration. Since the 1960s, demand has shifted away from routine cognitive (e.g., clerical work) and manual skills (warehouse picking and packing) toward nonroutine analytical (computer coding), interpersonal (nursing), and manual skills (home health attendant). This study aimed to determine whether individuals with serious mental illness are likely to hold the types of jobs that are in decline and to assess their ability to compete for the types of jobs that have been in increased demand. METHODS Using data from the National Health Interview Survey and the Occupational Information Network database on occupational skills (N=387,240 person-year responses), this study explored changes in patterns of employment from 1997 to 2017 for people with mental illnesses. RESULTS Individuals with any mental health condition experienced a 10.9 percentage point decline in employment in jobs requiring routine cognitive or any manual skills. Much of this decline was offset by an increase in employment in jobs involving nonroutine cognitive skills. However, individuals with serious psychological distress experienced a 7.9 percentage point decline in employment in jobs requiring routine cognitive or any manual skills, and about 75% of this decline coincided with reduced levels of employment rather than a shift toward employment in nonroutine cognitive jobs. These patterns were more striking among men. CONCLUSIONS Likely directions for interventions include renewed efforts at workplace accommodations, greater investment in evidence-based return-to-work programs, and efforts to popularize early intervention programs.
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Affiliation(s)
- Richard G Frank
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Wagner School of Public Service, New York University, New York (Glied); Department of Psychiatry, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields)
| | - Sherry A M Glied
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Wagner School of Public Service, New York University, New York (Glied); Department of Psychiatry, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields)
| | - Morgan Shields
- Department of Health Care Policy, Harvard Medical School, Boston (Frank); Wagner School of Public Service, New York University, New York (Glied); Department of Psychiatry, and Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia (Shields)
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21
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The Cal-DSH diversion guidelines. CNS Spectr 2020; 25:701-713. [PMID: 33111661 DOI: 10.1017/s1092852920001819] [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: 11/07/2022]
Abstract
The Cal-DSH Diversion Guidelines provide 10 general guidelines that jurisdictions should consider when developing diversion programs for individuals with a serious mental illness (SMI) who become involved in the criminal justice system. Screening for SMI in a jail setting is reviewed. In addition, important treatment interventions for SMI and substance use disorders are highlighted with the need to address criminogenic risk factors highlighted.
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22
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Choi DJ, Joung J, Kim E, Kim S. "Entry to the Society from the Schizophrenic Cave"- A Qualitative Meta-Synthesis of Job Experiences for People with Schizophrenia. Issues Ment Health Nurs 2020; 41:873-886. [PMID: 32497458 DOI: 10.1080/01612840.2020.1731892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reviews of employment among people with schizophrenia have primarily encompassed quantitative research. This study analyzes eight qualitative research studies published from 2000 to 2018 on the job experiences of people with schizophrenia to identify participants' job motivations, negative and positive experiences working with schizophrenia, and adaptations to gain social roles and values. We found that the core theme encompassing participants' experiences was the need for social support to facilitate reentry into society from the schizophrenic cave. These results could inform the development of targeted nursing interventions to provide social support and foster job adaptation for people with schizophrenia.
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Affiliation(s)
- Dug Ja Choi
- College of Nursing, the Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Jeawon Joung
- Department of Nursing, Semyung University, Jechoen, Korea
| | - Eunha Kim
- College of Nursing, the Research Institute of Nursing Science, Seoul National University, Seoul, Korea
| | - Sungjae Kim
- College of Nursing, the Research Institute of Nursing Science, Seoul National University, Seoul, Korea
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23
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Millner UC, Rogers ES, Bloch P, Costa W, Pritchett S, Woods T, Teixeira C, Hintz K. Unpacking the Meaning of Work for Individuals Living With Serious Mental Illness. JOURNAL OF CAREER DEVELOPMENT 2020. [DOI: 10.1177/0894845320941256] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals diagnosed with serious mental illnesses continue to experience work-related disparities despite the existence of evidence-based practices. Understanding the meaning of work among these individuals is key to developing interventions grounded in career development theory and practice. This qualitative inquiry adapted a consensual qualitative research approach and utilized a participatory component to conduct an in-depth exploration of the meaning of work among a national sample of young adults and older adults living with serious mental illness. The psychology of working perspective was applied to the results after analyses. Results revealed categories that clustered within four overarching domains pertaining to work as central to survival, social connectedness, self-determination, and mental health recovery as proposed by the theory. Implications for services, research, and policy are discussed.
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Affiliation(s)
| | | | - Philippe Bloch
- Center for Psychiatric Rehabilitation, Boston University, MA, USA
| | - William Costa
- Center for Psychiatric Rehabilitation, Boston University, MA, USA
| | - Sharon Pritchett
- Center for Psychiatric Rehabilitation, Boston University, MA, USA
| | | | - Carina Teixeira
- Center for Psychiatric Rehabilitation, Boston University, MA, USA
| | - Kathryn Hintz
- Center for Psychiatric Rehabilitation, Boston University, MA, USA
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Chan SKW, Pang HH, Yan KK, Hui CLM, Suen YN, Chang WC, Lee EHM, Sham P, Chen EYH. Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services. Br J Psychiatry 2020; 217:491-497. [PMID: 31284883 DOI: 10.1192/bjp.2019.161] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services. AIMS We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored. METHOD Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups. RESULTS There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1-5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group. CONCLUSIONS Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.
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Affiliation(s)
- Sherry Kit Wa Chan
- Clinical Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Herbert H Pang
- Assistant Professor, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Kang K Yan
- PhD student, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Christy Lai Ming Hui
- Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Yi Nam Suen
- Research Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Wing Chung Chang
- Clinical Associate Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Edwin Ho Ming Lee
- Clinical Assistant Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Pak Sham
- Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
| | - Eric Yu Hai Chen
- Clinical Professor, Department of Psychiatry, Li Ka Shing Faculty of Medicine, and The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
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Carpenter JS, Iorfino F, Cross S, Nichles A, Zmicerevska N, Crouse JJ, Palmer JR, Whitton AE, White D, Naismith SL, Guastella AJ, Hermens DF, Scott J, Scott EM, Hickie IB. Cohort profile: the Brain and Mind Centre Optymise cohort: tracking multidimensional outcomes in young people presenting for mental healthcare. BMJ Open 2020; 10:e030985. [PMID: 32229519 PMCID: PMC7170572 DOI: 10.1136/bmjopen-2019-030985] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The Brain and Mind Centre (BMC) Optymise cohort assesses multiple clinical and functional domains longitudinally in young people presenting for mental health care and treatment. Longitudinal tracking of this cohort will allow investigation of the relationships between multiple outcome domains across the course of care. Subsets of Optymise have completed detailed neuropsychological and neurobiological assessments, permitting investigation of associations between these measures and longitudinal course. PARTICIPANTS Young people (aged 12-30) presenting to clinics coordinated by the BMC were recruited to a research register (n=6743) progressively between June 2008 and July 2018. To date, 2767 individuals have been included in Optymise based on the availability of at least one detailed clinical assessment. MEASURES Trained researchers use a clinical research proforma to extract key data from clinical files to detail social and occupational functioning, clinical presentation, self-harm and suicidal thoughts and behaviours, alcohol and other substance use, physical health comorbidities, personal and family history of mental illness, and treatment utilisation at the following time points: baseline, 3, 6, 12, 24, 36, 48, and 60 months, and time last seen. FINDINGS TO DATE There is moderate to substantial agreement between raters for data collected via the proforma. While wide variations in individual illness course are clear, social and occupational outcomes suggest that the majority of cohort members show no improvement in functioning over time. Differential rates of longitudinal transition are reported between early and late stages of illness, with a number of baseline factors associated with these transitions. Furthermore, there are longitudinal associations between prior suicide attempts and inferior clinical and functional outcomes. FUTURE PLANS Future reports will detail the longitudinal course of each outcome domain and examine multidirectional relationships between these domains both cross-sectionally and longitudinally, and explore in subsets the associations between detailed neurobiological measures and clinical, social and functional outcomes.
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Affiliation(s)
- Joanne S Carpenter
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Frank Iorfino
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Shane Cross
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Alissa Nichles
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Natalia Zmicerevska
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jacob J Crouse
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jake R Palmer
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
| | - Alexis E Whitton
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Django White
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sharon L Naismith
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Psychology, The University of Sydney, Camperdown, New South Wales, Australia
- Charles Perkins Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Adam J Guastella
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Daniel F Hermens
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Jan Scott
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- Department of Academic Psychiatry, Newcastle University, Newcastle, United Kingdom
- Diderot University, Sorbonne City, Paris, France
| | - Elizabeth M Scott
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
- School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
| | - Ian B Hickie
- Brain & Mind Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Baller JB, Blyler CR, Bronnikov S, Xie H, Bond GR, Filion K, Hale T. Long-Term Follow-Up of a Randomized Trial of Supported Employment for SSDI Beneficiaries With Mental Illness. Psychiatr Serv 2020; 71:243-249. [PMID: 31795854 DOI: 10.1176/appi.ps.201800554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE In this study, the authors assessed the long-term impact of the Mental Health Treatment Study (MHTS), a randomized controlled trial testing the effects of providing 2 years of employment services based on the evidence-based individualized placement and support model to Social Security Disability Insurance (SSDI) recipients with serious mental illness. Treatment recipients also received systematic medication management, supplemental health care supports, and short-term relief from medical continuing disability review by the Social Security Administration (SSA). METHODS MHTS site data for 2,160 participants were linked to SSA administrative data from 2011 to 2015, 1 to 5 years after the original study concluded. Univariate and multivariate models were used to assess the MHTS effects on employment, earnings, and disability benefit suspension-termination up to 7 years after services ended. RESULTS The analyses showed that the treatment group was more likely than the control group to work, and average earnings among the treatment group increased more over time than earnings among the control group. Disability benefit suspension/termination did not differ between groups. CONCLUSIONS Providing the demonstration's package of services and support to SSDI beneficiaries with psychiatric disabilities for up to 2 years may have a long-term impact on employment and earnings. Under the SSDI program as currently structured, however, even after receiving 2 years of evidence-based supported employment and high-quality mental health services, SSDI beneficiaries with psychiatric conditions are unlikely to achieve economic independence within 5 years.
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Affiliation(s)
- Julia B Baller
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
| | - Crystal R Blyler
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
| | - Svetlana Bronnikov
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
| | - Haiyi Xie
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
| | - Gary R Bond
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
| | - Kai Filion
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
| | - Thomas Hale
- Mathematica Policy Research, Washington, D.C. (Baller, Blyler, Bronnikov); Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Xie); Westat, Rockville, Maryland (Bond); Social Security Administration, Baltimore (Filion, Hale)
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Harrison J, Krieger MJ, Johnson HA. Review of Individual Placement and Support Employment Intervention for Persons with Substance Use Disorder. Subst Use Misuse 2020; 55:636-643. [PMID: 31782349 DOI: 10.1080/10826084.2019.1692035] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives: Work is a critical part of recovery for many people with chronic health conditions, including Substance Use Disorders (SUD). Individual Placement and Support (IPS) is an evidence-based practice designed initially for adults with mental illness. Although the evidence for using IPS with individuals with severe mental illness is well documented, less is known about the efficacy of using IPS with consumers with substance use disorders, and the results have yet to be systematically evaluated and organized. Key components of zero exclusion, rapid competitive job search, and incorporation with treatment services as well as benefits are components that make IPS a strong practice to incorporate into substance abuse treatment. This study aims to evaluate and organize the evidence base of using IPS with adults with substance use disorders. Results: A systematic review was conducted of meta-analyses, reviews, and individual studies from 2000 through 2019, measuring the efficacy of IPS with individuals with SUD or comorbid SUD. Databases searched were Scopus, PubMed, and PsychInfo. Experimental and quasi-experimental studies are reviewed and critiqued for their application to a SUD population. Then, barriers and facilitators of IPS implementation with this population are discussed. Conclusions/Importance: There is a high evidence to support to application of IPS for persons with SUD, both singly and when combined with a mental health disorder. Barriers to IPS implementation including episodic treatment, risk of relapse, and housing or criminal justice instability make the IPS program a useful best practice to consider for this population.
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Affiliation(s)
- Jennifer Harrison
- School of Social Work, Western Michigan University, Kalamazoo, Michigan, USA
| | - Matthew J Krieger
- School of Social Work, Western Michigan University, Kalamazoo, Michigan, USA
| | - Hillary A Johnson
- School of Social Work, Western Michigan University, Kalamazoo, Michigan, USA
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Naslund JA, Aschbrenner KA. Risks to Privacy With Use of Social Media: Understanding the Views of Social Media Users With Serious Mental Illness. Psychiatr Serv 2019; 70:561-568. [PMID: 30947635 PMCID: PMC6602849 DOI: 10.1176/appi.ps.201800520] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Social media may afford new opportunities to enhance mental health services; however, privacy risks have received less attention. This study explored privacy risks of using social media for reasons related to mental health from the perspectives of social media users with serious mental illness. METHODS Twitter users who self-identified in their profile as having a serious mental illness participated in an online survey inquiring whether they were ever concerned about risks to their privacy when using social media for anything related to their mental illness. User characteristics were compared between those who were concerned about risks and those who were not. Participants' responses to an open-ended question about privacy risks were analyzed thematically. RESULTS Among 90 respondents who self-identified as having schizophrenia spectrum disorders (40%), bipolar disorder (37%), or major depressive disorder (23%), more than one-third (36%) expressed concerns about privacy risks with using social media. Risks were more frequently reported among respondents with a college degree, compared with those without a college degree, and among respondents who were currently working or in school, compared with those who were not currently working. Thematic analysis of participants' responses to the open-ended question yielded four categories of risk: threats to employment, fear of stigma and being judged, impact on personal relationships, and facing hostility or being hurt. CONCLUSIONS These findings offer preliminary insights about the types of privacy risks that individuals with serious mental illness are concerned about when using social media for their mental health. The findings can inform the safety of future social media interventions.
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Affiliation(s)
- John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Aschbrenner)
| | - Kelly A Aschbrenner
- Department of Global Health and Social Medicine, Harvard Medical School, Boston (Naslund); Department of Psychiatry, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire (Aschbrenner)
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Can Öz Y, Ünsal Barlas G, Yildiz M. Opinions and Expectations Related to Job Placement of Individuals with Schizophrenia: A Qualitative Study Including Both Patients and Employers. Community Ment Health J 2019; 55:865-872. [PMID: 30715635 DOI: 10.1007/s10597-019-00374-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Accepted: 01/28/2019] [Indexed: 10/27/2022]
Abstract
The present study was conducted to identify the problems related to the placement of individuals with schizophrenia into jobs, the conditions allowing them to keep working and to reveal obstacles to their employment. The depth-interview technique was used for obtaining information from both patients with schizophrenia (n = 25) and the human resource managers of selected companies (n = 8). All interviews were recorded, transcribed and assessed using a thematic analysis approach. After the evaluation of qualitative data, the main emerging themes included the problems and suggestions of the patients, the worries of the employers about persons with schizophrenia and things that they could do about employment. The results of this study can be used to identify solutions to the problem as they were obtained from the individuals who were personally experiencing employment difficulties and from the employers, who were in a position to help solve the problems.
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Affiliation(s)
- Yüksel Can Öz
- Department of Psychiatric Nursing, Faculty of Health Sciences, Kocaeli University, Umuttepe, 41380, Izmit, Kocaeli, Turkey.
| | - Gül Ünsal Barlas
- Department of Psychiatric Nursing, Faculty of Health Sciences, Marmara University, Istanbul, Turkey
| | - Mustafa Yildiz
- Department of Psychiatry, Faculty of Medicine, Kocaeli University, Izmit, Kocaeli, Turkey
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Bond GR, Drake RE, Pogue JA. Expanding Individual Placement and Support to Populations With Conditions and Disorders Other Than Serious Mental Illness. Psychiatr Serv 2019; 70:488-498. [PMID: 30813865 DOI: 10.1176/appi.ps.201800464] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A systematic review of studies of individual placement and support (IPS) for populations other than those with serious mental illness was conducted. METHODS The authors searched three electronic databases (PubMed, Web of Science, and Scopus) for studies of IPS and modified IPS. Eligibility criteria for the systematic review included randomized controlled trials with prospective data collection on competitive employment rate and at least 10 study participants from a well-defined population other than people with serious mental illness. Results were compiled for competitive employment rates, IPS fidelity, and other outcomes. RESULTS Three clinical groups other than people with serious mental illness have been studied: people with psychiatric disorders other than serious mental illness, people with substance use disorders, and people with musculoskeletal or neurological disorders. Nine controlled trials with a total of 2,902 participants included six trials with people who had psychiatric disorders other than serious mental illness, two with people who had substance use disorders, and one with people who had spinal cord injuries. In eight studies, results for competitive employment rates significantly favored IPS. Meta-analysis yielded an overall weighted odds ratio of 2.23 (95% confidence interval=1.53-3.24, p<.001). Findings for other employment outcomes also favored IPS, but findings on symptom reduction and quality of life were inconsistent. The strongest (and only replicated) findings were for veterans with posttraumatic stress disorder (PTSD). Methodological limitations included small samples, major modifications to IPS fidelity, and short follow-up periods. CONCLUSIONS IPS, often with modifications, is a promising employment intervention for several populations in addition to people with serious mental illnesses. The strongest evidence pertains to veterans with PTSD. IPS should be offered to these veterans. Research on other populations, including people with anxiety, depression, substance use disorder, musculoskeletal or neurological conditions, or pain syndromes, needs development, amplification, and replication.
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Evensen S, Wisløff T, Lystad JU, Bull H, Martinsen EW, Ueland T, Falkum E. Exploring the potential cost-effectiveness of a vocational rehabilitation program for individuals with schizophrenia in a high-income welfare society. BMC Psychiatry 2019; 19:140. [PMID: 31064371 PMCID: PMC6505225 DOI: 10.1186/s12888-019-2130-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 04/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the past decades research has shown that employment has a positive impact on quality of life, global functioning and recovery in individuals with schizophrenia. However, access to vocational rehabilitation services for this group is limited and unemployment rates remain high. In this study we explore the potential cost-effectiveness of a novel vocational rehabilitation program (The Job Management Program - JUMP) earmarked for individuals with schizophrenia in Norway. METHODS The JUMP study was a vocational rehabilitation program augmented with either cognitive behaviour therapy or cognitive remediation. In addition to the JUMP protocol, we extracted treatment cost data from comprehensive and mandatory health and welfare registers. The costs over a two-year follow-up period were compared with the costs over the two-year period prior to inclusion in the study. We also compared the cost-effectiveness of JUMP with a treatment as usual group (TAU). RESULTS We identified significant reductions in inpatient services in the JUMP group, both for those who obtained employment and those who did not. Significant reductions were also found in the TAU group, but adjusted for baseline differences the total cost for JUMP participants were € 10,621 lower than in the TAU group during the follow-up period. CONCLUSION In addition to supporting individuals with schizophrenia obtain employment, JUMP appears to have reduced the reliance on mental health services, which should be of interest to stakeholders. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01139502 . Retrospectively registered on 6 February 2010.
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Affiliation(s)
- Stig Evensen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torbjørn Wisløff
- Department of Infectious Disease Epidemiology and Modelling, Norwegian Institute of Public Health, Oslo, Norway
- Department of Health Management and Health Economics, University of Oslo, Oslo, Norway
| | - June Ullevoldsæter Lystad
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Helen Bull
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Egil W. Martinsen
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torill Ueland
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Erik Falkum
- Department of Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Department of Clinical Medicine, University of Oslo, Oslo, Norway
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Stallvik M, Flemmen G, Salthammer JA, Nordfjærn T. Assessing health service satisfaction among users with substance use disorders within the municipalities in Norway. Subst Abuse Treat Prev Policy 2019; 14:18. [PMID: 31060571 PMCID: PMC6501295 DOI: 10.1186/s13011-019-0207-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 04/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to assess what is associated with health service satisfaction among adults with a substance use disorder receiving services provided within different municipalities in Norway. An additional aim was to examine demographic and municipality characteristics, mental health, and types of substance use associated with health service satisfaction. METHOD A cross-sectional partial explorative study was executed in 2017 among 491 service users with substance use disorders from 20 randomly selected municipalities. The sample consisted of 70% males. The sample majority were single and unemployed, and their main sources of healthcare were the general practitioner (78%), The Norwegian Labor and Welfare Administration (72%), and addiction counsellors (62%). RESULTS Overall satisfaction was negatively associated with age, size of municipality, Global Severity Index (GSI) and illicit substance use during the last 12 months. Satisfaction with practical help, such as housing, economy, work and education, was negatively associated with GSI and positively associated with onset of first alcohol intoxication. Satisfaction with personnel was positively associated with onset of first alcohol intoxication and negatively associated with municipality size, GSI and illicit use the last 12 months. The results showed that more than half of the respondents (54%) to a large or great extent were satisfied with the overall services provided. The services they were less satisfied with were related to housing, economy, getting started with exercise and establishing a social network. CONCLUSION The results show areas associated with satisfaction and domains where the municipalities can improve their services to meet the users' needs and increase service satisfaction.
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Affiliation(s)
- Marianne Stallvik
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Grete Flemmen
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Jo Arild Salthammer
- Center of Drug and Alcohol expertise, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
| | - Trond Nordfjærn
- Department of Research and Development, Clinic of Substance Use and Addiction Medicine, St. Olavs University Hospital, Trondheim, Norway
- Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Dewa CS, Hoch JS, Corbière M, Villotti P, Trojanowski L, Sultan-Taïeb H, Zaniboni S, Fraccaroli F. A Comparison of Healthcare Use and Costs for Workers with Psychiatric Disabilities Employed in Social Enterprises Versus Those Who Are Not Employed and Seeking Work. Community Ment Health J 2019; 55:202-210. [PMID: 29737444 DOI: 10.1007/s10597-018-0281-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/23/2018] [Indexed: 12/01/2022]
Abstract
Because of work's contribution to recovery, governments have moved to improve employment rates of people with severe mental disorders (SMDs). Social enterprises (SEs) have been identified as a means to achieve employment. In Ontario, Canada, the Ministry of Health and Long-Term Care (MOHLTC) have provided SEs government subsidies. Public funding arrangements create a potential trade-off for governments that must decide how to distribute constrained budgets to meet a variety of public needs. In Ontario, the government is potentially faced with choosing between supporting employment versus healthcare services. This study addresses the question, are there significant differences in service use and costs from the MOHLTC's perspective for people with SMDs working in SEs versus those who are not working and looking for work? Our results indicate there is a significant difference in healthcare use between the two groups suggesting there could be less healthcare use associated with SE employment.
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Affiliation(s)
- Carolyn S Dewa
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, 2230 Stockton Boulevard, Sacramento, CA, 95817, USA.
| | - Jeffrey S Hoch
- Division of Health Policy and Management, Department of Public Health Sciences, University of California, Davis, 2103 Stockton Boulevard, Sacramento, CA, 95817, USA
| | - Marc Corbière
- Department of Education, Career Counselling, Université du Québec à Montréal, 1205, rue Saint-Denis, Montréal, QC, H2X 3R9, Canada.,Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
| | - Patrizia Villotti
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, Canada
| | - Lucy Trojanowski
- Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON, M5S 2S1, Canada
| | - Hélène Sultan-Taïeb
- Département d'organisation et ressources humaines, Université du Québec à Montréal, 315 Sainte-Catherine Est, Local R-3225, Montréal, QC, H2X 3X2, Canada
| | - Sara Zaniboni
- Department of Psychology, University of Bologna, Via Zamboni, 33, 40126, Bologna, Italy
| | - Franco Fraccaroli
- Department of Psychology and Cognitive Science, University of Trento, Corso Bettini, 31, 38068, Rovereto, Italy
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Drake RE, Becker DR, Bond GR. Introducing Individual Placement and Support (IPS) supported employment in Japan. Psychiatry Clin Neurosci 2019; 73:47-49. [PMID: 30370626 DOI: 10.1111/pcn.12792] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/12/2018] [Indexed: 11/30/2022]
Abstract
Individual Placement and Support is a standardized model of supported employment, developed initially for people with serious mental disorders and now applied to people with a range of disabilities. More than two dozen randomized controlled trials around the world show that the approach helps a majority of participants to succeed in competitive employment. Individual Placement and Support is spreading rapidly across the USA and in many other high-income countries, with facilitation by an international learning community.
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Takeda K, Sugawara N, Yamada Y, Nagata T, Kashiwagi H, Kono T, Hirabayashi N, Okada T. Employment-Related Factors of Forensic Psychiatric Outpatients with Psychotic Disorders. Neuropsychiatr Dis Treat 2019; 15:3341-3350. [PMID: 31819459 PMCID: PMC6897063 DOI: 10.2147/ndt.s228916] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Employment is important for forensic psychiatric patients with psychotic disorders, in terms of reduction in symptoms, improving the quality of life, and preventing re-offenses. However, few detailed studies on employment status in such patients exist. We aimed to determine the employment rate among forensic psychiatric outpatients with psychotic disorders and identify the factors associated with employment. PATIENTS AND METHODS The study population comprised 406 patients with psychotic disorders who completed a forensic outpatient treatment order, were aged <65 years at discharge from a forensic psychiatric ward and provided written informed consent. Psychotic disorders were defined as psychiatric disorders classified into F2 in the International Statistical Classification of Diseases and Related Health Problems, 10th edition. Demographic data were collected from the medical records of the inpatient treatment period. Prognostic data during the outpatient treatment order period was provided by the reintegration coordinators responsible for coordinating the patients' social environment during this period. Exploratory univariate and multivariable logistic regression analyses identified the factors associated with employment. RESULTS The mean age at discharge was 44.4±10.8 years. The mean follow-up period was 2.69±1.01 years. There were 4.6 times more men (n=334) than women (n=72). During the outpatient treatment order period, 56 of 406 participants achieved employment (13.8%). Participants who committed serious crime, including homicide, arson, robbery, and sexual assault, had a lower employment rate compared to participants who committed bodily injury crimes (multivariable odds ratio, 0.421; 95% confidence interval, 0.220-0.807). History of substance use and living with family after discharge from a forensic psychiatric ward positively contributed to employment. CONCLUSION The employment rate among forensic psychiatric outpatients with psychotic disorders was low and was similar to that reported in previous studies on general psychiatric patients with schizophrenia. Furthermore, serious criminal behavior negatively impacted employment.
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Affiliation(s)
- Koji Takeda
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo 187-8551, Japan.,Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Norio Sugawara
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi 321-0843, Japan
| | - Yuji Yamada
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo 187-8551, Japan
| | - Takako Nagata
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo 187-8551, Japan
| | - Hiroko Kashiwagi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo 187-8551, Japan
| | - Toshiaki Kono
- Department of Community Mental Health and Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo 187-8553, Japan
| | - Naotsugu Hirabayashi
- Department of Psychiatry, National Center of Neurology and Psychiatry Hospital, Kodaira, Tokyo 187-8551, Japan
| | - Takayuki Okada
- Section of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
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Gmitroski T, Bradley C, Heinemann L, Liu G, Blanchard P, Beck C, Mathias S, Leon A, Barbic SP. Barriers and facilitators to employment for young adults with mental illness: a scoping review. BMJ Open 2018; 8:e024487. [PMID: 30567825 PMCID: PMC6303634 DOI: 10.1136/bmjopen-2018-024487] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The issue of gaining employment for those with mental illness is a growing global concern. For many in the young adult population, who are at a transitional age, employment is a central goal. In response, we conducted a scoping review to answer the question, 'What are the barriers and facilitators to employment for young adults with mental illness?' DESIGN We conducted a scoping review in accordance to the Arksey and O'Malley framework. We performed a thorough search of Medline, EMBASE, CINAHL, ABI/INFORM, PsycINFO and Cochrane. We included studies that considered young adults aged 15-29 years of age with a mental health diagnosis, who were seeking employment or were included in an employment intervention. RESULTS Our search resulted in 24 research articles that focused on employment for young adults with mental illness. Four main themes were extracted from the literature: (1) integrated health and social services, (2) age-exposure to employment supports, (3) self-awareness and autonomy and (4) sustained support over the career trajectory. CONCLUSIONS Our review suggests that consistent youth-centred employment interventions, in addition to usual mental health treatment, can facilitate young adults with mental illness to achieve their employment goals. Aligning the mental health and employment priorities of young adults may result in improved health and social outcomes for this population while promoting greater engagement of young adults in care.
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Affiliation(s)
- Taryn Gmitroski
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Christl Bradley
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Lyn Heinemann
- Canadian Mental Health Association, Vancouver, British Columbia, Canada
| | - Grace Liu
- Providence Health, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
| | - Paige Blanchard
- Providence Health, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
| | - Charlotte Beck
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steve Mathias
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adelena Leon
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Occupational Science and Occupational Therapy, UBC, Vancouver, British Columbia, Canada
- Foundry, Vancouver, British Columbia, Canada
- UBC Library, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Psychiatry, St Paul's Hospital, Vancouver, British Columbia, Canada
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Gardsjord ES, Romm KL, Røssberg JI, Friis S, Barder HE, Evensen J, Haahr U, Ten Velden Hegelstad W, Joa I, Johannessen JO, Langeveld J, Larsen TK, Opjordsmoen S, Rund BR, Simonsen E, Vaglum P, Melle I. Depression and functioning are important to subjective quality of life after a first episode psychosis. Compr Psychiatry 2018; 86:107-114. [PMID: 30114656 DOI: 10.1016/j.comppsych.2018.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/05/2018] [Accepted: 07/26/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Subjective quality of life (S-QoL) is an important outcome measure in first-episode psychosis, but its associations with clinical predictors may vary across the illness course. In this study we examine the association pattern, including both direct and indirect effects, between specific predefined clinical predictors (insight, depression, positive psychotic symptoms and global functioning) and S-QoL the first ten years after a first-episode psychosis. METHODS Three hundred and one patients with a first-episode psychosis were included at first treatment, and reassessed at 3 months, 1 year, 2 years, 5 years and 10 years after inclusion. At 10-year follow-up 186 participated. S-QoL was assessed with Lehman's Quality of Life Interview. Applying a structural equation model, we investigated cross-sectional association patterns at all assessments between the predefined clinical predictors and S-QoL. RESULTS At baseline, only depression was significantly associated with S-QoL. At all follow-up assessments, depression and functioning showed significant associations with S-QoL. Insight was not associated with S-QoL at any of the assessments. Better insight, less depressive symptoms and less positive psychotic symptoms were all associated with higher functioning at all assessments. Functioning seems to mediate a smaller indirect inverse association between positive psychotic symptoms and S-QoL. The association pattern was stable across all follow-up assessments. CONCLUSIONS Together with depression, functioning seems to be important for S-QoL. Functioning seems to be a mediating factor between positive symptoms and S-QoL. A focus on functional outcome continues to be important.
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Affiliation(s)
- Erlend Strand Gardsjord
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway.
| | - Kristin Lie Romm
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Jan Ivar Røssberg
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Svein Friis
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | | | - Julie Evensen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Adult Psychiatric Department Vinderen, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | - Ulrik Haahr
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark
| | - Wenche Ten Velden Hegelstad
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Inge Joa
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Jan Olav Johannessen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Faculty of Social Sciences, University of Stavanger, 4036 Stavanger, Norway
| | - Johannes Langeveld
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway
| | - Tor Ketil Larsen
- Psychiatric Division, Network of Clinical Psychosis Research, Stavanger University Hospital, 4068 Stavanger, Norway; Department of Clinical Medicine, Section Psychiatry, University of Bergen, 5021 Bergen, Norway
| | - Stein Opjordsmoen
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway
| | - Bjørn Rishovd Rund
- Department of Psychology, University of Oslo, P.O. 1094 Blindern, 0317 Oslo, Norway; Vestre Viken Hospital Trust, 3004 Drammen, Norway
| | - Erik Simonsen
- Psychiatric Research Unit, Region Zealand, 4000 Roskilde, Denmark; Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark
| | - Per Vaglum
- Department of Behavioural Sciences in Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, KG Jebsen Centre for Psychosis Research, Norwegian Centre for Mental Disorders Research, Faculty of Medicine, University of Oslo, 0316 Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
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Predictors of Sustained Employment Among Individuals With Serious Mental Illness: Findings From a 5-Year Naturalistic Longitudinal Study. J Nerv Ment Dis 2018; 206:669-679. [PMID: 30124576 DOI: 10.1097/nmd.0000000000000876] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite decades of research, understanding of the employment trajectories of individuals with serious mental illnesses remains elusive. We conducted a 5-year prospective, longitudinal study using a geographically broad sample of individuals who met established criteria for sustained competitive employment (N = 529). We collected data on an annual basis with a specifically designed survey instrument. Despite stable employment at study entry, more than half of the participants experienced work interruptions during the 5-year follow-up period. Predictors of sustained employment included the absence of a trauma diagnosis, Social Security disability income, psychiatric hospitalizations, and difficulties with daily functioning. The presence of a higher quality of life, workplace supports, and a flexible job were also predictive. Results dispel the myth that people with serious mental illnesses cannot be employed for prolonged periods. Interruptions in work trajectories, however, suggest that longer-term supports may increase individuals' capacity to maintain stable employment.
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Dean EE, Shogren KA, Hagiwara M, Wehmeyer ML. How does employment influence health outcomes? A systematic review of the intellectual disability literature. JOURNAL OF VOCATIONAL REHABILITATION 2018. [DOI: 10.3233/jvr-180950] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Evan E. Dean
- Beach Center on Disability/Kansas University Center on Developmental Disabilities, Lawrence, KS, USA
- Department of Occupational Therapy Education, University of Kansas, Kansas City, KS, USA
| | - Karrie A. Shogren
- Beach Center on Disability/Kansas University Center on Developmental Disabilities, Lawrence, KS, USA
| | - Mayumi Hagiwara
- Beach Center on Disability/Kansas University Center on Developmental Disabilities, Lawrence, KS, USA
| | - Michael L. Wehmeyer
- Beach Center on Disability/Kansas University Center on Developmental Disabilities, Lawrence, KS, USA
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40
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Alegria M, Drake RE, Kang HA, Metcalfe J, Liu J, DiMarzio K, Ali N. Simulations Test Impact Of Education, Employment, And Income Improvements On Minority Patients With Mental Illness. Health Aff (Millwood) 2018; 36:1024-1031. [PMID: 28583960 DOI: 10.1377/hlthaff.2017.0044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Social determinants of health, such as poverty and minority background, severely disadvantage many people with mental disorders. A variety of innovative federal, state, and local programs have combined social services with mental health interventions. To explore the potential effects of such supports for addressing poverty and disadvantage on mental health outcomes, we simulated improvements in three social determinants-education, employment, and income. We used two large data sets: one from the National Institute of Mental Health that contained information about people with common mental disorders such as anxiety and depression, and another from the Social Security Administration that contained information about people who were disabled due to severe mental disorders such as schizophrenia and bipolar disorder. Our simulations showed that increasing employment was significantly correlated with improvements in mental health outcomes, while increasing education and income produced weak or nonsignificant correlations. In general, minority groups as well as the majority group of non-Latino whites improved in the desired outcomes. We recommend that health policy leaders, state and federal agencies, and insurers provide evidence-based employment services as a standard treatment for people with mental disorders.
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Affiliation(s)
- Margarita Alegria
- Margarita Alegria is a professor in the Departments of Medicine and Psychiatry at Harvard Medical School and chief of the Disparities Research Unit, Department of Medicine, at Massachusetts General Hospital, both in Boston
| | - Robert E Drake
- Robert E. Drake is at the IPS Employment Center at Westat, in Lebanon, New Hampshire
| | - Hyeon-Ah Kang
- Hyeon-Ah Kang is a postdoctoral research scientist in the Department of Statistics, Columbia University, in New York City
| | - Justin Metcalfe
- Justin Metcalfe is a doctoral candidate at the Dartmouth Institute, in Lebanon, New Hampshire
| | - Jingchen Liu
- Jingchen Liu is an associate professor in the Department of Statistics at Columbia University
| | - Karissa DiMarzio
- Karissa DiMarzio is a research assistant in the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
| | - Naomi Ali
- Naomi Ali is a research assistant in the Disparities Research Unit, Department of Medicine, Massachusetts General Hospital
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41
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A Pilot Test of Group Based Cognitive Behavioral Therapy to Augment Vocational Services for Persons With Serious Mental Illness: Feasibility and Competitive Work Outcomes. J Nerv Ment Dis 2018; 206:310-315. [PMID: 29485477 DOI: 10.1097/nmd.0000000000000796] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Persons with serious mental illness (SMI) struggle with work functioning even with the assistance of vocational services. The current study sought to address this problem by examining a cognitive-behavioral therapy to augment vocational services. Fifty-two adults with SMI receiving vocational services participated in a pre-post feasibility trial of the Cognitive Behavior Therapy for Work Success (CBTw) intervention. CBTw is a 12-week manualized intervention that addresses cognitive and behavioral factors that impact work functioning. Competitive work outcomes were assessed in the 12 weeks preceding baseline and after the intervention. The results demonstrate strong session attendance and a low attrition rate. There were also significant improvements in work outcomes. Specifically, among participants unemployed at baseline, 50.0% attained work during follow-up. These findings provide preliminary evidence that CBTw may be a feasible intervention to augment vocational services; further controlled research should examine its benefit to work outcomes in people with SMI.
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Linnemørken LTB, Sveinsdottir V, Knutzen T, Rødevand L, Hernæs KH, Reme SE. Protocol for the Individual Placement and Support (IPS) in Pain Trial: A randomized controlled trial investigating the effectiveness of IPS for patients with chronic pain. BMC Musculoskelet Disord 2018; 19:47. [PMID: 29433493 PMCID: PMC5809966 DOI: 10.1186/s12891-018-1962-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 02/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background Work disability involves large costs to the society as well as to the individual. Work disability is common among people with chronic pain conditions, yet few effective interventions exist. Individual Placement and Support (IPS) is an evidence-based work rehabilitation model originally developed to help people with severe mental illness obtain and maintain employment. The effectiveness of IPS for patients with severe mental illness is well documented, but the model has never before been tested for patients with chronic pain. Methods/design The aim of the IPS in Pain trial is to investigate the effectiveness of IPS as an integrated part of the interdisciplinary treatment for patients with chronic pain in a hospital outpatient clinic. The study is a randomized controlled trial comparing pain treatment with integrated IPS to treatment as usual in unemployed patients suffering from various chronic pain conditions. The primary outcome of the study is labor market participation during 12 months after enrollment, and secondary outcomes include physical and mental health and well-being, collected at baseline, 6, and 12 months. Finally, there will be an additional long-term follow-up for the primary outcome, which will be collected through a brief phone interview at 24 months. Discussion The IPS in Pain trial will be the first report of the effectiveness of the IPS model of supported employment applied in an outpatient setting for chronic pain patients. It will thus provide important information about the effectiveness of repurposing IPS to a new patient group in great need of job support. Trial registration Clinicaltrials.gov: NCT02697656. Registered January 15th, 2016.
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Affiliation(s)
| | | | - Thomas Knutzen
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway
| | - Linn Rødevand
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway.,NORMENT, KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Silje Endresen Reme
- Department of Pain Management and Research, Oslo University Hospital, Oslo, Norway. .,Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.
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Thornton RLJ, Glover CM, Cené CW, Glik DC, Henderson JA, Williams DR. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff (Millwood) 2018; 35:1416-23. [PMID: 27503966 DOI: 10.1377/hlthaff.2015.1357] [Citation(s) in RCA: 330] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The opportunities for healthy choices in homes, neighborhoods, schools, and workplaces can have decisive impacts on health. We review scientific evidence from promising interventions focused on the social determinants of health and discuss how such interventions can improve population health and reduce health disparities. We found sufficient evidence of successful outcomes to support disparity-reducing policy interventions targeted at education and early childhood; urban planning and community development; housing; income enhancements and supplements; and employment. Cost-effectiveness evaluations show that these interventions lead to long-term societal savings, but the interventions require more routine attention to cost considerations. We discuss challenges to implementation, including the need for long-term financing to scale up effective interventions for implementation at the local, state, and national levels.
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Affiliation(s)
- Rachel L J Thornton
- Rachel L. J. Thornton is an assistant professor in the Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, at the Johns Hopkins School of Medicine, in Baltimore, Maryland
| | - Crystal M Glover
- Crystal M. Glover is an assistant professor and BMO Harris Bank Health Disparities Research Fellow at the Rush University Medical School, in Chicago, Illinois
| | - Crystal W Cené
- Crystal W. Cené is an associate professor in the Division of General Medicine and Clinical Epidemiology, Department of Medicine, at the Chapel Hill School of Medicine, University of North Carolina
| | - Deborah C Glik
- Deborah C. Glik is a professor of community health sciences at the UCLA Fielding School of Public Health, University of California, Los Angeles
| | - Jeffrey A Henderson
- Jeffrey A. Henderson is president and CEO of the Black Hills Center for American Indian Health, in Rapid City, South Dakota
| | - David R Williams
- David R. Williams is the Florence and Laura Norman Professor of Public Health in the Department of Social and Behavioral Sciences at the Harvard T. H. Chan School of Public Health, in Boston, Massachusetts, and a professor in the Department of African and African American Studies at Harvard University, in Cambridge, Massachusetts
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44
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Müller HHO. Effective and underprescribed: what about clozapine? Ment Illn 2017; 9:7193. [PMID: 29142664 PMCID: PMC5661131 DOI: 10.4081/mi.2017.7193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 05/18/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Helge H O Müller
- Department of Psychiatry, Carl von Ossietzky University Oldenburg, Germany
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45
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Dom G. Work is Important. Commentary on Finn et al. (2017) Decisions to Attend and Drink at Party Events: The Effects of Incentives and Disincentives and Lifetime Alcohol and Antisocial Problems. Alcohol Clin Exp Res 2017; 42:9-11. [PMID: 29044564 DOI: 10.1111/acer.13530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 10/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium.,Antwerp University Hospital (UZA), Edegem, Belgium
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Vornholt K, Villotti P, Muschalla B, Bauer J, Colella A, Zijlstra F, Van Ruitenbeek G, Uitdewilligen S, Corbière M. Disability and employment – overview and highlights. EUROPEAN JOURNAL OF WORK AND ORGANIZATIONAL PSYCHOLOGY 2017. [DOI: 10.1080/1359432x.2017.1387536] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Katharina Vornholt
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Patrizia Villotti
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CRIUSMM), Department of Education, Career Counselling, Université du Québec à Montréal, Montréal, Canada
| | - Beate Muschalla
- Research Group Psychosomatic Rehabilitation (FPR), Charité Berlin, Hindenburgdamm, Berlin, Germany
| | - Jana Bauer
- Lehrstuhl für Arbeit und Berufliche Rehabilitation, Universität zu Köln, Köln
| | - Adrienne Colella
- A.B. Freeman School of Business, Tulane University, New Orleans, LA, USA
| | - Fred Zijlstra
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Gemma Van Ruitenbeek
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sjir Uitdewilligen
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Marc Corbière
- Centre de recherche de l’Institut universitaire en santé mentale de Montréal (CRIUSMM), Department of Education, Career Counselling, Université du Québec à Montréal, Montréal, Canada
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47
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Nicholson J, Carpenter-Song EA, MacPherson LH, Tauscher JS, Burns TC, Lord SE. Developing the WorkingWell mobile app to promote job tenure for individuals with serious mental illnesses. Psychiatr Rehabil J 2017; 40:276-282. [PMID: 27322395 PMCID: PMC7480984 DOI: 10.1037/prj0000201] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Individuals living with serious mental illnesses are key stakeholders in user experience design and the development of the WorkingWell mobile app to enhance on-the-job follow-along support. In this study, Individual Placement and Support (IPS) consumers identify challenges in sustaining employment, provide data regarding their use of technology, and suggest technology-based solutions for coping on the job to inform app development. METHOD Focus groups were conducted in 3 agencies providing IPS services to examine consumers' perspectives on supported employment, work, and their preferences for technology-based supports. Qualitative data were coded thematically in a multistep, collaborate approach to ensure trustworthiness. Survey data were collected to describe participants and their current technology use; these data were analyzed descriptively. RESULTS A total of 25 IPS consumers reported work challenges related to interpersonal relationships and social situations; job characteristics, tasks, and expectations; illness- and treatment-related issues; lifestyle/wellness and conditions apart from work; and motivation. The majority owned mobile phones, felt comfortable using technology, and could see how technology-based tools could help sustain employment. Participants highlighted the potential benefits of technology-based supports for work challenges, and underscored the potential for independence and empowerment as a consequence. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Study findings suggest the value of a WorkingWell mobile app that is innovative, easy to access, self-directed, and individually tailored to enhance IPS follow-along support. The WorkingWell app, if proven effective, will provide an empowering set of tools designed with input from individuals with serious mental illnesses, and integrated into a single, accessible interface. (PsycINFO Database Record
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Affiliation(s)
- Joanne Nicholson
- Dartmouth Psychiatric Research Center, Center for Technology & Behavioral Health, The Geisel School of Medicine
| | | | - Lynn H MacPherson
- Dartmouth Psychiatric Research Center, Center for Technology & Behavioral Health, The Geisel School of Medicine
| | - Justin S Tauscher
- Dartmouth Psychiatric Research Center, Center for Technology & Behavioral Health, The Geisel School of Medicine
| | | | - Sarah E Lord
- Dartmouth Psychiatric Research Center, Center for Technology & Behavioral Health, The Geisel School of Medicine
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48
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Lee RSC, Hermens DF, Scott J, O'Dea B, Glozier N, Scott EM, Hickie IB. A transdiagnostic study of education, employment, and training outcomes in young people with mental illness. Psychol Med 2017; 47:2061-2070. [PMID: 28393749 DOI: 10.1017/s0033291717000484] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Optimizing functional recovery in young individuals with severe mental illness constitutes a major healthcare priority. The current study sought to quantify the cognitive and clinical factors underpinning academic and vocational engagement in a transdiagnostic and prospective youth mental health cohort. The primary outcome measure was 'not in education, employment or training' ('NEET') status. METHOD A clinical sample of psychiatric out-patients aged 15-25 years (n = 163) was assessed at two time points, on average, 24 months apart. Functional status, and clinical and neuropsychological data were collected. Bayesian structural equation modelling was used to confirm the factor structure of predictors and cross-lagged effects at follow-up. RESULTS Individually, NEET status, cognitive dysfunction and negative symptoms at baseline were predictive of NEET status at follow-up (p < 0.05). Baseline cognitive functioning was the only predictor of follow-up NEET status in the multivariate Bayesian model, while controlling for baseline NEET status. For every 1 s.d. deficit in cognition, the probability of being disengaged at follow-up increased by 40% (95% credible interval 19-58%). Baseline NEET status predicted poorer negative symptoms at follow-up (β = 0.24, 95% credible interval 0.04-0.43). CONCLUSIONS Disengagement with education, employment or training (i.e. being NEET) was reported in about one in four members of this cohort. The initial level of cognitive functioning was the strongest determinant of future NEET status, whereas being academically or vocationally engaged had an impact on future negative symptomatology. If replicated, these findings support the need to develop early interventions that target cognitive phenotypes transdiagnostically.
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Affiliation(s)
- R S C Lee
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - D F Hermens
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - J Scott
- Academic Psychiatry,Institute of Neuroscience, Newcastle University, Newcastle upon Tyne,UK
| | - B O'Dea
- Faculty of Medicine,Black Dog Institute, UNSW,Sydney, NSW,Australia
| | - N Glozier
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - E M Scott
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
| | - I B Hickie
- Brain and Mind Centre, University of Sydney,Sydney, NSW,Australia
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Cartwright KA, Lecomte T, Corbière M, Lysaker P. Narrative development and supported employment of persons with severe mental illness. J Ment Health 2017. [PMID: 28644705 DOI: 10.1080/09638237.2017.1340606] [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: 10/19/2022]
Abstract
Background: While the relationship between objective recovery and work among persons with severe mental illness (SMI) is well-established, few studies have examined the link between subjective recovery and employment.Aims: The study investigated the prospective relationship between narrative development at the start of supported employment (SE) and positive work outcomes.Methods: The authors employed a time-limited, mixed-method longitudinal design to examine the relationship between the baseline narrative development of 38 SE participants with SMI and employment outcomes eight months later, as well as whether narratives evolved over the course of the study.Results: While narrative development was unrelated to work for the 59% of participants who were employed at the end of the study, unemployed individuals showed more developed baseline narratives overall, as well as enriched baseline emotional connectedness and social worth. Higher emotional connectedness at the start of SE programs was predictive of fewer hours worked eight months later, controlling for executive functioning, negative symptoms and self-esteem. Although workers showed no narrative changes over time, those without work demonstrated increased agency over the eight months of the study.Conclusion: Further research is warranted to clarify the relationship between richer personal narratives and unemployment.
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Affiliation(s)
| | | | | | - Paul Lysaker
- Roudebush VA Medical Centre, Indiana University School of Medicine, Indianapolis, IN, USA
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50
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Ikebuchi E, Sato S, Yamaguchi S, Shimodaira M, Taneda A, Hatsuse N, Watanabe Y, Sakata M, Satake N, Nishio M, Ito JI. Does improvement of cognitive functioning by cognitive remediation therapy effect work outcomes in severe mental illness? A secondary analysis of a randomized controlled trial. Psychiatry Clin Neurosci 2017; 71:301-308. [PMID: 27873453 DOI: 10.1111/pcn.12486] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 10/19/2016] [Accepted: 11/16/2016] [Indexed: 11/29/2022]
Abstract
AIM The aim of this study was to clarify whether improvement of cognitive functioning by cognitive remediation therapy can improve work outcome in schizophrenia and other severe mental illnesses when combined with supported employment. METHODS The subjects of this study were persons with severe mental illness diagnosed with schizophrenia, major depression, or bipolar disorder (ICD-10) and cognitive dysfunction who participated in both cognitive remediation using the Thinking Skills for Work program and a supported employment program in a multisite, randomized controlled study. Logistic and multiple linear regression analyses were performed to clarify the influence of cognitive functioning on vocational outcomes, adjusting for demographic and clinical variables. RESULTS Improvement of cognitive functioning with cognitive remediation significantly contributed to the total days employed and total earnings of competitive employment in supported employment service during the study period. Any baseline demographic and clinical variables did not significantly contribute to the work-related outcomes. CONCLUSION A cognitive remediation program transferring learning skills into the real world is useful to increase the quality of working life in supported employment services for persons with severe mental illness and cognitive dysfunction who want to work competitively.
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Affiliation(s)
- Emi Ikebuchi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Sayaka Sato
- Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Sosei Yamaguchi
- Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Michiyo Shimodaira
- Department of Mental Health/Psychiatric Nursing, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ayano Taneda
- Department of Psychiatric Rehabilitation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Norifumi Hatsuse
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Yukako Watanabe
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Masuhiro Sakata
- National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Naoko Satake
- National Center of Neurology and Psychiatry, National Center Hospital, Tokyo, Japan
| | - Masaaki Nishio
- Tohoku Fukushi University School of Welfare, Sendai, Japan
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