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Song J, Zhang YX, Qin MN, Ren JX, Jia YN, Yu H, Zhou YQ. Experiences of returning to work in patients with schizophrenia after treatment: A longitudinal qualitative study. Int J Soc Psychiatry 2024; 70:588-600. [PMID: 38343195 DOI: 10.1177/00207640231223423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND Returning to work (RTW) has always been regarded as one of the important indicators to evaluate the therapeutic effect of patients with schizophrenia. The existing studies on RTW in patients with schizophrenia are mostly focused on intervention measures, and the qualitative research on RTW is very limited. The purpose of this study was to evaluate the experience of the RTW after treatment in patients with schizophrenia. METHOD A longitudinal qualitative study was conducted involving 24 patients with schizophrenia in China. The interviews were held at three time-points during their RTW process, (1) when patients had improved and were close to discharge, (2) within 1 month post-discharge, and (3) 6 months post-discharge. The interview recordings were transcribed by the research team, and transcripts were independently analyzed by two independent coders using reflexive thematic analysis. RESULTS A total of 24 patients with schizophrenia participated in 72 personal interviews. The thematic framework based on the experience of patients with schizophrenia reveals a three-phases of the process of RTW: improved, being at a loss, and job crisis. The study identified one theme of the first phase: the expectation and optimism. Two themes in the second phase: (1) psychological distress of upcoming work; (2) expectation of assistance pre-work. And four themes in the third phase: (1) tremendous pressure of RTW; (2) lack of medical and social support; (3) social status and interpersonal relationships change; and (4) high level of financial pressure. CONCLUSION The experience of RTW is a dynamic process with great challenges in each phase, patients with schizophrenia have been deeply affected by what they have experienced. There is an urgent need to ensure that existing community and social support is integrated into daily care to support patients with schizophrenia to RTW successful. The findings of this study also suggest relevant departments and employers should be aware of the barriers to RTW for patients with schizophrenia, and take certain measures to change the current situation.
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Affiliation(s)
- Jin Song
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yu-Xin Zhang
- Department of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Meng-Nan Qin
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Jia-Xin Ren
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yan-Nan Jia
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Hong Yu
- Department of Nursing, Harbin Medical University, Heilongjiang, China
| | - Yu-Qiu Zhou
- Department of Nursing, Harbin Medical University, Heilongjiang, China
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2
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Hennekam S, Follmer K, Beatty J. Exploring mental illness in the workplace:the role of HR professionals and processes. INTERNATIONAL JOURNAL OF HUMAN RESOURCE MANAGEMENT 2021. [DOI: 10.1080/09585192.2021.1960751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
| | - Kayla Follmer
- John Chambers College of Business and Economics, West Virginia University Morgantown, WV, USA
| | - Joy Beatty
- College of Business, Eastern Michigan University, Ypsilanti, MI, USA
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3
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How do recovery-oriented interventions contribute to personal mental health recovery? A systematic review and logic model. Clin Psychol Rev 2020; 76:101815. [DOI: 10.1016/j.cpr.2020.101815] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/14/2019] [Accepted: 01/03/2020] [Indexed: 01/16/2023]
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4
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Brinchmann B, Widding-Havneraas T, Modini M, Rinaldi M, Moe CF, McDaid D, Park AL, Killackey E, Harvey SB, Mykletun A. A meta-regression of the impact of policy on the efficacy of individual placement and support. Acta Psychiatr Scand 2020; 141:206-220. [PMID: 31733146 DOI: 10.1111/acps.13129] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Individual placement and support (IPS) has shown consistently better outcomes on competitive employment for patients with severe mental illness than traditional vocational rehabilitation. The evidence for efficacy originates from few countries, and generalization to different countries has been questioned. This has delayed implementation of IPS and led to requests for country-specific RCTs. This meta-analysis examines if evidence for IPS efficacy can be generalized between rather different countries. METHODS A systematic search was conducted according to PRISMA guidelines to identify RCTs. Overall efficacy was established by meta-analysis. The generalizability of IPS efficacy between countries was analysed by random-effects meta-regression, employing country- and date-specific contextual data obtained from the OECD and the World Bank. RESULTS The systematic review identified 27 RCTs. Employment rates are more than doubled in IPS compared with standard vocational rehabilitation (RR 2.07 95% CI 1.82-2.35). The efficacy of IPS was marginally moderated by strong legal protection against dismissals. It was not moderated by regulation of temporary employment, generosity of disability benefits, type of integration policies, GDP, unemployment rate or employment rate for those with low education. CONCLUSIONS The evidence for efficacy of IPS is very strong. The efficacy of IPS can be generalized between countries.
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Affiliation(s)
- B Brinchmann
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway
| | - T Widding-Havneraas
- Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway
| | - M Modini
- School of Psychology, The University of Sydney, Sydney, NSW, Australia.,Concord Centre for Mental Health, NSW Health, Sydney, NSW, Australia
| | - M Rinaldi
- South West London & St George's Mental Health NHS Trust, London, UK
| | - C F Moe
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - D McDaid
- Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - A-L Park
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,Care Policy and Evaluation Centre, Department of Health Policy, London School of Economics and Political Science, London, UK
| | - E Killackey
- Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, Vic, Australia
| | - S B Harvey
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - A Mykletun
- Nordland Hospital Trust, Centre for Work and Mental Health, Bodø, Norway.,UiT - The Arctic University of Norway, Tromsø, Norway.,Centre for Research and Education in Forensic Psychiatry and Psychology, Haukeland University Hospital, Bergen, Norway.,Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
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Lannigan EG, Noyes S. Occupational Therapy Interventions for Adults Living With Serious Mental Illness. Am J Occup Ther 2019; 73:7305395010p1-7305395010p5. [PMID: 31484037 DOI: 10.5014/ajot.2019.735001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Occupational therapy practitioners have education, skills, and knowledge to provide occupational therapy interventions for adults living with serious mental illness. Evidence-based interventions demonstrate that occupational therapy practitioners can enable this population to engage in meaningful occupations, participate in community living, and contribute to society. Systematic review findings for occupational therapy interventions for adults living with serious mental illness were published in the September/October 2018 issue of the American Journal of Occupational Therapy and in the Occupational Therapy Practice Guidelines for Adults Living With Serious Mental Illness. Each article in the Evidence Connection series summarizes evidence from the published reviews on a given topic and presents an application of the evidence to a related clinical case. These articles illustrate how research evidence from the reviews can be used to inform and guide clinical decision making. Through a case story, this article illustrates how current evidence is applied for effective occupational therapy intervention with an adult living with serious mental illness.
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Affiliation(s)
- Elizabeth Griffin Lannigan
- Elizabeth Griffin Lannigan, PhD, OTR/L, FAOTA, is Adjunct Faculty, Department of Occupational Therapy, College of Health and Human Services, University of New Hampshire, Durham;
| | - Susan Noyes
- Susan Noyes, PhD, OTR/L, is Associate Professor, Master of Occupational Therapy Program, University of Southern Maine, Lewiston
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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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Tampi RR, Young J, Hoq R, Resnick K, Tampi DJ. Psychotic disorders in late life: a narrative review. Ther Adv Psychopharmacol 2019; 9:2045125319882798. [PMID: 31662846 PMCID: PMC6796200 DOI: 10.1177/2045125319882798] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Accepted: 09/25/2019] [Indexed: 11/25/2022] Open
Abstract
Psychotic disorders are not uncommon in late life. These disorders often have varied etiologies, different clinical presentations, and are associated with significant morbidity and mortality among the older adult population. Psychotic disorders in late life develop due to the complex interaction between various biological, psychological, social, and environmental factors. Given the significant morbidity and mortality associated with psychotic disorders in late life, a comprehensive work-up should be conducted when they are encountered. The assessment should not only identify the potential etiologies for the psychotic disorders, but also recognize factors that predicts possible outcomes for these disorders. Treatment approaches for psychotic disorders in late life should include a combination of nonpharmacological management strategies with the judicious use of psychotropic medications. When antipsychotic medications are necessary, they should be used cautiously with the goal of optimizing outcomes with regular monitoring of their efficacy and adverse effects.
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Affiliation(s)
- Rajesh R Tampi
- Department of Psychiatry and Behavioral Sciences, Cleveland Clinic Akron General, Akron, OH 44307, USA
| | - Juan Young
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Rakin Hoq
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
| | - Kyle Resnick
- NeoMed/Summa Psychiatry Residency Program, Akron, OH, USA
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8
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Noyes S, Sokolow H, Arbesman M. Evidence for Occupational Therapy Intervention With Employment and Education for Adults With Serious Mental Illness: A Systematic Review. Am J Occup Ther 2018; 72:7205190010p1-7205190010p10. [PMID: 30157005 DOI: 10.5014/ajot.2018.033068] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Many of the estimated 9.8 million American adults with serious mental illness (SMI) want to engage in employment and education, yet the majority report a need for more skills training. This review presents evidence for the effectiveness of interventions that occupational therapy practitioners can provide to help people with SMI improve and maintain performance and participation in employment and education. METHOD Citations, abstracts, and full-text articles in databases including MEDLINE, PsycINFO, CINAHL, OTseeker, and the Cochrane Database of Systematic Reviews were reviewed for inclusion and analysis. RESULTS Fifty-seven articles met criteria for inclusion. For employment, strong evidence was found for the Individual Placement and Support (IPS) model and cognitive interventions. For education, moderate evidence was found for supported education interventions. CONCLUSION This systematic review supports the role of occupational therapy practitioners in promoting the implementation of IPS, cognitive-based, and social skills programs to improve vocational and educational outcomes for adults with SMI.
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Affiliation(s)
- Susan Noyes
- Susan Noyes, PhD, OTR/L, is Assistant Professor, Occupational Therapy Program, University of Southern Maine, Lewiston;
| | - Helena Sokolow
- Helena Sokolow, MOT, OTR, is Adjunct Instructor, Occupational Therapy Program, University of Southern Maine, Lewiston
| | - Marian Arbesman
- Marian Arbesman, PhD, OTR/L, FAOTA, is Adjunct Associate Professor, Department of Clinical Research and Leadership, George Washington University School of Medicine and Health Sciences, Washington, DC, and President, ArbesIdeas, Inc., Williamsville, NY
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Kukla M, Bell MD, Lysaker PH. A randomized controlled trial examining a cognitive behavioral therapy intervention enhanced with cognitive remediation to improve work and neurocognition outcomes among persons with schizophrenia spectrum disorders. Schizophr Res 2018; 197:400-406. [PMID: 29422299 DOI: 10.1016/j.schres.2018.01.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 11/02/2017] [Accepted: 01/17/2018] [Indexed: 11/26/2022]
Abstract
This single blind, three-armed randomized controlled trial compared cognitive behavioral therapy (CBT) enhanced with cognitive remediation (CBT+CR) to CBT alone and an active control condition on work and neurocognition outcomes for persons with schizophrenia spectrum disorders. Seventy-five adult outpatients with schizophrenia or schizoaffective disorder were randomized to three study conditions (N=25 per group). The CBT intervention was the Indianapolis Vocational Intervention program (IVIP), consisting of weekly group and individual sessions focused on work-related content. Participants in the CBT+CR group received IVIP and Posit Science computer-based cognitive training. The active control group consisted of weekly vocational support groups and individual vocational support sessions. All participants were placed into a noncompetitive work assignment and were followed for 26weeks. Data collection included hours worked, weekly work performance ratings, and neurocognition assessed at baseline and 6months. Neurocognition was also assessed at 12months. Data were analyzed using multilevel linear models to account for nested, repeated measures data. Results indicate that participants in the CBT+CR condition worked significantly more hours and had a more positive trajectory of improving global work performance and work quality across the study compared with the CBT alone and vocational support condition. Compared to the other conditions, CBT+CR also had a significant increase in overall neurocognition that continued to the 12month follow-up, particularly in the domains of verbal learning and social cognition. In conclusion, CBT+CR may be an effective intervention to improve work functioning and neurocognition in persons with schizophrenia.
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Affiliation(s)
- Marina Kukla
- HSR&D Center for Health Information and Communication, Richard L. Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN, USA; Indiana University-Purdue University Indianapolis, Department of Psychology, 402 N. Blackford St., Indianapolis, IN 46202, USA.
| | - Morris D Bell
- Yale University School of Medicine, 300 George St., New Haven, CT, 06511, USA; VA Connecticut Healthcare System, Psychology Service 116B, VACHS, 950 Campbell Avenue, West Haven, CT, 06516, USA.
| | - Paul H Lysaker
- Roudebush VA Medical Center, 1481 W. 10th Street, Indianapolis, IN 46202, USA; Indiana University School of Medicine, 340 W. 10th Street, Suite 6200, Indianapolis, IN 46202, USA.
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Suijkerbuijk YB, Schaafsma FG, van Mechelen JC, Ojajärvi A, Corbière M, Anema JR. Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis. Cochrane Database Syst Rev 2017; 9:CD011867. [PMID: 28898402 PMCID: PMC6483771 DOI: 10.1002/14651858.cd011867.pub2] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND People with severe mental illness show high rates of unemployment and work disability, however, they often have a desire to participate in employment. People with severe mental illness used to be placed in sheltered employment or were enrolled in prevocational training to facilitate transition to a competitive job. Now, there are also interventions focusing on rapid search for a competitive job, with ongoing support to keep the job, known as supported employment. Recently, there has been a growing interest in combining supported employment with other prevocational or psychiatric interventions. OBJECTIVES To assess the comparative effectiveness of various types of vocational rehabilitation interventions and to rank these interventions according to their effectiveness to facilitate competitive employment in adults with severe mental illness. SEARCH METHODS In November 2016 we searched CENTRAL, MEDLINE, Embase, PsychINFO, and CINAHL, and reference lists of articles for randomised controlled trials and systematic reviews. We identified systematic reviews from which to extract randomised controlled trials. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised controlled trials evaluating the effect of interventions on obtaining competitive employment for adults with severe mental illness. We included trials with competitive employment outcomes. The main intervention groups were prevocational training programmes, transitional employment interventions, supported employment, supported employment augmented with other specific interventions, and psychiatric care only. DATA COLLECTION AND ANALYSIS Two authors independently identified trials, performed data extraction, including adverse events, and assessed trial quality. We performed direct meta-analyses and a network meta-analysis including measurements of the surface under the cumulative ranking curve (SUCRA). We assessed the quality of the evidence for outcomes within the network meta-analysis according to GRADE. MAIN RESULTS We included 48 randomised controlled trials involving 8743 participants. Of these, 30 studied supported employment, 13 augmented supported employment, 17 prevocational training, and 6 transitional employment. Psychiatric care only was the control condition in 13 studies. Direct comparison meta-analysis of obtaining competitive employmentWe could include 18 trials with short-term follow-up in a direct meta-analysis (N = 2291) of the following comparisons. Supported employment was more effective than prevocational training (RR 2.52, 95% CI 1.21 to 5.24) and transitional employment (RR 3.49, 95% CI 1.77 to 6.89) and prevocational training was more effective than psychiatric care only (RR 8.96, 95% CI 1.77 to 45.51) in obtaining competitive employment.For the long-term follow-up direct meta-analysis, we could include 22 trials (N = 5233). Augmented supported employment (RR 4.32, 95% CI 1.49 to 12.48), supported employment (RR 1.51, 95% CI 1.36 to 1.68) and prevocational training (RR 2.19, 95% CI 1.07 to 4.46) were more effective than psychiatric care only. Augmented supported employment was more effective than supported employment (RR 1.94, 95% CI 1.03 to 3.65), transitional employment (RR 2.45, 95% CI 1.69 to 3.55) and prevocational training (RR 5.42, 95% CI 1.08 to 27.11). Supported employment was more effective than transitional employment (RR 3.28, 95% CI 2.13 to 5.04) and prevocational training (RR 2.31, 95% CI 1.85 to 2.89). Network meta-analysis of obtaining competitive employmentWe could include 22 trials with long-term follow-up in a network meta-analysis.Augmented supported employment was the most effective intervention versus psychiatric care only in obtaining competitive employment (RR 3.81, 95% CI 1.99 to 7.31, SUCRA 98.5, moderate-quality evidence), followed by supported employment (RR 2.72 95% CI 1.55 to 4.76; SUCRA 76.5, low-quality evidence).Prevocational training (RR 1.26, 95% CI 0.73 to 2.19; SUCRA 40.3, very low-quality evidence) and transitional employment were not considerably different from psychiatric care only (RR 1.00,95% CI 0.51 to 1.96; SUCRA 17.2, low-quality evidence) in achieving competitive employment, but prevocational training stood out in the SUCRA value and rank.Augmented supported employment was slightly better than supported employment, but not significantly (RR 1.40, 95% CI 0.92 to 2.14). The SUCRA value and mean rank were higher for augmented supported employment.The results of the network meta-analysis of the intervention subgroups favoured augmented supported employment interventions, but also cognitive training. However, supported employment augmented with symptom-related skills training showed the best results (RR compared to psychiatric care only 3.61 with 95% CI 1.03 to 12.63, SUCRA 80.3).We graded the quality of the evidence of the network ranking as very low because of potential risk of bias in the included studies, inconsistency and publication bias. Direct meta-analysis of maintaining competitive employment Based on the direct meta-analysis of the short-term follow-up of maintaining employment, supported employment was more effective than: psychiatric care only, transitional employment, prevocational training, and augmented supported employment.In the long-term follow-up direct meta-analysis, augmented supported employment was more effective than prevocational training (MD 22.79 weeks, 95% CI 15.96 to 29.62) and supported employment (MD 10.09, 95% CI 0.32 to 19.85) in maintaining competitive employment. Participants receiving supported employment worked more weeks than those receiving transitional employment (MD 17.36, 95% CI 11.53 to 23.18) or prevocational training (MD 11.56, 95% CI 5.99 to 17.13).We did not find differences between interventions in the risk of dropouts or hospital admissions. AUTHORS' CONCLUSIONS Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.
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Affiliation(s)
- Yvonne B Suijkerbuijk
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Frederieke G Schaafsma
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
| | - Joost C van Mechelen
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
| | - Anneli Ojajärvi
- Finnish Institute of Occupational HealthTopeliuksenkatu 41 a AHelsinkiFinlandFI‐00250
| | - Marc Corbière
- Université du Québec à Montréal (UQAM)Department of Education and Pedagogy ‐ Career CounselingMontrealQCCanada
- Centre de recherche de l'Institut universitaire en santé mentale de Montréal (CR‐IUSMM)MontrealCanada
| | - Johannes R Anema
- VU University Medical CenterDepartment of Public and Occupational Health, Amsterdam Public Health Research InstituteVan der Boechorststraat 7Postbus 7057AmsterdamNetherlands1007 MB
- AMC‐UMCG‐UWV‐VUmcResearch Centre for Insurance MedicineAmsterdamNetherlands
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Stacy MA, Stefanovics E, Rosenheck R. Reasons for job loss among homeless veterans in supported employment. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2017. [DOI: 10.1080/15487768.2016.1267049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Meaghan A. Stacy
- Department of Psychology, VA Connecticut Health Care System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Elina Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut, USA
| | - Robert Rosenheck
- Department of Psychology, VA Connecticut Health Care System, West Haven, Connecticut, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
- VA New England Mental Illness Research, Education, and Clinical Center, West Haven, Connecticut, USA
- Department of Epidemiology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
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Kirsh B. Client, Contextual and Program Elements Influencing Supported Employment: A Literature Review. Community Ment Health J 2016; 52:809-20. [PMID: 27055809 DOI: 10.1007/s10597-015-9936-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/02/2015] [Indexed: 11/29/2022]
Abstract
Supported employment is an evidence-based practice with a well-established research base. Most studies track such outcomes as employment rates, time to employment and wages earned. Few studies address client and contextual factors that impact outcomes or consider program elements beyond those that comprise the individual placement and support model. This paper reviews existing literature to shed light on the following questions: (1) What impact do labour market trends have on the effectiveness of SE? (2) How lasting are the effects of SE and what factors influence longevity of SE effects? (3) What levels and types of employment are targeted by SE? (4) What are the characteristics of people who benefit from SE? (5) What is the role of peer support in SE? and (6) What are the barriers to effective SE implementation? Research findings are synthesized and suggestions for service enhancements are offered so that the model can continue to evolve.
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Affiliation(s)
- Bonnie Kirsh
- Department of Occupational Science and Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, Canada. .,Rehabilitation Sciences Institute, University of Toronto, 500 University Avenue, Toronto, Canada.
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Obtaining employment as an anchor for estimating the minimum clinically important difference on the Positive and Negative Syndrome Scale (PANSS) in schizophrenia. Psychiatry Res 2016; 238:304-309. [PMID: 27086249 DOI: 10.1016/j.psychres.2016.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 10/16/2015] [Accepted: 02/12/2016] [Indexed: 11/23/2022]
Abstract
Statistical differences on clinical scales are often used to compare the effectiveness of treatments. However, statistical significance does not necessarily indicate clinical significance. The minimum clinically important difference (MCID) refers to clinically meaningful treatment differences. This study estimates the MCID of the Positive and Negative Syndrome Scale (PANSS) by anchoring the change in scores to an objective clinical outcome: employment. This secondary analysis compared PANSS score change from baseline among 1049 non-working individuals with schizophrenia, who were followed and categorized as either having not worked, worked 1-10 days, or worked >10 days at 15 or 18 months. The difference in change in average PANSS Total scores between participants who did not work and those who worked 1-10 days (4.25 points) and >10 days (8.30) were statistically significant. This study estimates the MCID for the PANSS to be between 4.25 and 8.30 Total points. This study revealed significant differences in PANSS score changes between participants who did and did not work. Using employment, an objective and clinically meaningful change in health status, to determine the MCID of PANSS resulted in estimates lower than previously reported. MCID estimates vary across methods but using objective anchors increases face validity.
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Gold PB, Macias C, Rodican CF. Does Competitive Work Improve Quality of Life for Adults with Severe Mental Illness? Evidence from a Randomized Trial of Supported Employment. J Behav Health Serv Res 2016; 43:155-71. [PMID: 24504832 PMCID: PMC4636477 DOI: 10.1007/s11414-014-9392-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
A randomized trial comparing a facility-based Clubhouse (N = 83) to a mobile Program of Assertive Community Treatment (PACT; N = 84) tested the widely held belief that competitive employment improves global quality of life for adults with severe mental illness. Random regression analyses showed that, over 24 months of study participation, competitively employed Clubhouse participants reported greater global quality of life improvement, particularly with the social and financial aspects of their lives, as well as greater self-esteem and service satisfaction, compared to competitively employed PACT participants. However, there was no overall association between global quality of life and competitive work, or work duration. Future research will determine whether these findings generalize to other certified Clubhouses or to other types of supported employment. Multi-site studies are needed to identify key mechanisms for quality of life improvement in certified Clubhouses, including the possibly essential role of Clubhouse employer consortiums for providing high-wage, socially integrated jobs.
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Affiliation(s)
- Paul B Gold
- Department of Counseling, Higher Education, and Special Education, University of Maryland at College Park, College Park, MD, 20742, USA.
| | - Cathaleene Macias
- Community Intervention Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Charles F Rodican
- Community Intervention Research, McLean Hospital, Belmont, MA, USA
- Harvard Medical School, Boston, MA, USA
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Zaprutko T, Kus K, Bilobryvka R, Rakhman L, Göder R, Michalak M, Pogłodziński A, Nowakowska E. Schizophrenia and Employment: Evaluation From Professionals Point of View. Psychiatr Q 2015; 86:569-79. [PMID: 25736799 DOI: 10.1007/s11126-015-9354-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Schizophrenia is a severe and chronic disorder requiring long-lasting and comprehensive treatment. Because of this disorder patients are socially isolated. Consequently, schizophrenia has a significant economic burden both in a group of direct and indirect costs. The aim was to analyse experts' opinions in the field of psychiatry concerning work possibilities among people with schizophrenia and to present the importance of employment for more effective treatment. A worldwide study was conducted between June 2011 and June 2013 using a questionnaire consisting of six open-closed questions and a short metrics. The questionnaire was delivered to experts and spread all over the world by post and via the internet. Over 3000 questionnaires were sent and the addressed specialists were requested to return them. From received 403 questionnaires 320 were included into the study, based on adopted inclusion and exclusion criteria. Although patients are afraid of looking for a job, respondents indicated that they crave for employment. The number of people that are able to work during remission of schizophrenia is considerably higher (50.35 %) than the number of actually employed (15.85 %). Non-pharmacological therapies were indicated as important to improve patients' chances of finding a job during remission of schizophrenia. The number of people that can work during remission of schizophrenia is considerably higher than the number of affected people employed. Patients crave for a job and supported employment should be treated as priority by health-care decision makers.
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Affiliation(s)
- Tomasz Zaprutko
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland.
| | - Krzysztof Kus
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland
| | - Rostyslav Bilobryvka
- Department of Psychiatry, Psychology and Sexology, Lviv National Medical University, 95 Kulparkivska Street, 79021, Lviv, Ukraine
| | - Lyudmyla Rakhman
- Department of Psychiatry, Psychology and Sexology, Lviv National Medical University, 95 Kulparkivska Street, 79021, Lviv, Ukraine
| | - Robert Göder
- Department of Psychiatry and Psychotherapy, Christian-Albrechts-Universität zu Kiel, 147 Niemannsweg Street, 24105, Kiel, Germany
| | - Michał Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland
| | - Andrzej Pogłodziński
- Department of Adult Psychiatry, Poznan University of Medical Sciences, 27 Szpitalna Street, 60572, Poznań, Poland
| | - Elżbieta Nowakowska
- Department of Pharmacoeconomics and Social Pharmacy, Poznan University of Medical Sciences, 79 Dąbrowskiego Street, 60529, Poznań, Poland
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Sveinsdottir V, Løvvik C, Fyhn T, Monstad K, Ludvigsen K, Øverland S, Reme SE. Protocol for the effect evaluation of Individual Placement and Support (IPS): a randomized controlled multicenter trial of IPS versus treatment as usual for patients with moderate to severe mental illness in Norway. BMC Psychiatry 2014; 14:307. [PMID: 25403470 PMCID: PMC4244061 DOI: 10.1186/s12888-014-0307-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Accepted: 10/20/2014] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Roughly one third of disability pensions in Norway are issued for mental and behavioral disorders, and vocational rehabilitation offered to this group has traditionally been dominated by train-and-place approaches with assisted or sheltered employment. Based on a more innovative place-and-train approach, Individual Placement and Support (IPS) involves supported employment in real-life competitive work settings, and has shown great promise for patients with severe mental illness. METHODS/DESIGN The study is a multicenter Randomized Controlled Trial (RCT) of IPS in a Norwegian context, involving an effect evaluation, a process evaluation, and a cost/benefit analysis. IPS will be compared to high quality treatment as usual (TAU), with labor market participation and educational activity at 12 months post inclusion as the primary outcome. The primary outcome will be measured using register data, and the project will also include complete follow-up up to 4 years after inclusion for long-term outcome data. Secondary outcomes include mental health status, disability and quality of life, collected through survey questionnaires at baseline, and after 6 and 12 months. Participants will include patients undergoing treatment for moderate to severe mental illness who are either unemployed or on sickness or social benefits. The estimated total sample size of 400-500 will be randomly assigned to the interventions. To be eligible, participants must have an expressed desire to work, and sufficient Norwegian reading and writing skills to fill out the questionnaires. DISCUSSION The Effect Evaluation of Individual Placement and Support (IPS) will be one of the largest randomized controlled trials to date investigating the effectiveness of IPS on competitive employment, and the first study to evaluate the effectiveness of IPS for patients with moderate to severe mental illness within a Norwegian context. TRIAL REGISTRATION Clinicaltrials.gov: NCT01964092 . Registered October 16th, 2013.
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Affiliation(s)
| | - Camilla Løvvik
- Uni Research Health, Uni Research, POB 7810, Bergen, NO-5020, Norway.
- Department of Psychosocial Science, University of Bergen, POB 7807, Bergen, NO-5020, Norway.
| | - Tonje Fyhn
- Uni Research Health, Uni Research, POB 7810, Bergen, NO-5020, Norway.
| | - Karin Monstad
- Uni Rokkan Centre, Uni Research, Nygårdsgaten 5, Bergen, NO-5015, Norway.
| | - Kari Ludvigsen
- Uni Rokkan Centre, Uni Research, Nygårdsgaten 5, Bergen, NO-5015, Norway.
| | - Simon Øverland
- Department of Public Mental Health, Division of Mental Health, Norwegian Institute of Public Health, Nydalen, POB 4404, Oslo, NO-0403, Norway.
- Department of Psychosocial Science, University of Bergen, POB 7807, Bergen, NO-5020, Norway.
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Luciano A, Bond GR, Drake RE. Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophr Res 2014; 159:312-21. [PMID: 25278105 DOI: 10.1016/j.schres.2014.09.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/29/2014] [Accepted: 09/04/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION This review synthesized prospective evidence to assess whether achieving employment alters the course of schizophrenia-spectrum disorder. METHOD Researchers identified relevant analyses for review via PubMed, expert referral, and reference review and systematically applied two levels of screening to 1484 citations using seven a priori criteria. RESULTS A total of 12 analyses representing eight cohorts, or 6844 participants, compared illness course over time by employment status in majority schizophrenia-spectrum samples. Employment was consistently associated with reductions in outpatient psychiatric treatment (2 of 2 studies) as well as improved self-esteem (2 of 2 studies). Employment was inconsistently associated with positive outcomes in several other areas, including symptom severity, psychiatric hospitalization, life satisfaction, and global wellbeing. Employment was consistently unrelated to worsening outcomes. DISCUSSION Achieving employment does not cause harm among people with schizophrenia-spectrum disorder and other severe mental illnesses. Further detailed mechanistic analyses of adequately powered long-term follow-up studies using granular descriptions of employment are needed to clarify the nature of associations between employment and hypothesized benefit.
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Affiliation(s)
- Alison Luciano
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| | - Gary R Bond
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
| | - Robert E Drake
- Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Rivermill Commercial Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH 03766, United States.
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Leddy M, Stefanovics E, Rosenheck R. Health and well-being of homeless veterans participating in transitional and supported employment: Six-month outcomes. JOURNAL OF REHABILITATION RESEARCH AND DEVELOPMENT 2014; 51:161-75. [PMID: 24805902 DOI: 10.1682/jrrd.2013.01.0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 07/22/2013] [Indexed: 11/05/2022]
Abstract
Supported employment, specifically individual placement and support (IPS), improves competitive employment (CE) rates for individuals with serious mental illness, but has not shown greater improvement in non-vocational outcomes than other rehabilitation approaches. The Department of Veterans Affairs offers two types of vocational services, IPS and transitional work experience (TWE), but no study has compared the effectiveness of these approaches. This secondary analysis of data from a study of homeless veterans compared 6 mo improvement in diverse outcomes for five employment patterns: never worked, worked only in TWE, worked in TWE followed by CE, worked in CE without IPS, and worked in CE with IPS referral. Veterans referred to IPS were more likely to be competitively employed. Those who worked in CE (whether following TWE or with or without IPS referral) showed the greatest increase in days worked, employment income, and total income and the greatest decrease in public support income when compared with those who worked only in TWE or not at all. Veterans in TWE showed the greatest increase in residential treatment days, but there were no other differences in non-vocational outcomes between groups. There are multiple paths to CE, but few differences in non-vocational outcomes across employment experiences.
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Affiliation(s)
- Meaghan Leddy
- Department of Veterans Affairs Connecticut Healthcare System, 950 Campbell Ave, Bldg 15, Rm 127, West Haven, CT 06516.
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Lim Y, Millington M, Mpofu E. The Evidentiary Basis for Supported Employment Practice for Workers with Schizophrenia: A Thematic Analysis. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2014. [DOI: 10.1080/15487768.2013.877409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Hellström L, Bech P, Nordentoft M, Lindschou J, Eplov LF. The effect of IPS-modified, an early intervention for people with mood and anxiety disorders: study protocol for a randomised clinical superiority trial. Trials 2013; 14:442. [PMID: 24368060 PMCID: PMC3879652 DOI: 10.1186/1745-6215-14-442] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Accepted: 12/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anxiety and affective disorders can be disabling and have a major impact on the ability to work. In Denmark, people with a mental disorder, and mainly non-psychotic disorders, represent a substantial and increasing part of those receiving disability pensions. Previous studies have indicated that Individual Placement and Support (IPS) has a positive effect on employment when provided to people with severe mental illness. This modified IPS intervention is aimed at supporting people with recently diagnosed anxiety or affective disorders in regaining their ability to work and facilitate their return to work or education. AIM To investigate whether an early modified IPS intervention has an effect on employment and education when provided to people with recently diagnosed anxiety or affective disorders in a Danish context. METHODS/DESIGN The trial is a randomised, assessor-blinded, clinical superiority trial of an early modified IPS intervention in addition to treatment-as-usual compared to treatment-as-usual alone for 324 participants diagnosed with an affective disorder or anxiety disorder living in the Capital Region of Denmark. The primary outcome is competitive employment or education at 24 months. Secondary outcomes are days of competitive employment or education, illness symptoms and level of functioning including quality of life at follow-up 12 and 24 months after baseline. DISCUSSION If the modified IPS intervention is shown to be superior to treatment-as-usual, a larger number of disability pensions can probably be avoided and long-term sickness absences reduced, with major benefits to society and patients. This trial will add to the evidence of how best to support people's return to employment or education after a psychiatric disorder. TRIAL REGISTRATION NCT01721824.
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Affiliation(s)
- Lone Hellström
- Copenhagen University Hospital, Research Unit, Mental Health Centre Copenhagen, Bispebjerg Bakke 23, DK-2400 Copenhagen, Denmark.
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Kinoshita Y, Furukawa TA, Kinoshita K, Honyashiki M, Omori IM, Marshall M, Bond GR, Huxley P, Amano N, Kingdon D. Supported employment for adults with severe mental illness. Cochrane Database Syst Rev 2013; 2013:CD008297. [PMID: 24030739 PMCID: PMC7433300 DOI: 10.1002/14651858.cd008297.pub2] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND People who suffer from severe mental disorder experience high rates of unemployment. Supported employment is an approach to vocational rehabilitation that involves trying to place clients in competitive jobs without any extended preparation. The Individual placement and support (IPS) model is a carefully specified form of supported employment. OBJECTIVES 1. To review the effectiveness of supported employment compared with other approaches to vocational rehabilitation or treatment as usual.2. Secondary objectives were to establish how far:(a) fidelity to the IPS model affects the effectiveness of supported employment,(b) the effectiveness of supported employment can be augmented by the addition of other interventions. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (February 2010), which is compiled by systematic searches of major databases, handsearches and conference proceedings. SELECTION CRITERIA All relevant randomised clinical trials focusing on people with severe mental illness, of working age (normally 16 to 70 years), where supported employment was compared with other vocational approaches or treatment as usual. Outcomes such as days in employment, job stability, global state, social functioning, mental state, quality of life, satisfaction and costs were sought. DATA COLLECTION AND ANALYSIS Two review authors (YK and KK) independently extracted data. For binary outcomes, we calculated risk ratio (RR) and its 95% confidence interval (CI), on an intention-to-treat basis. For continuous data, we estimated mean difference (MD) between groups and its 95% (CI). We employed a fixed-effect model for analyses. A random-effects model was also employed where heterogeneity was present. MAIN RESULTS A total of 14 randomised controlled trials were included in this review (total 2265 people). In terms of our primary outcome (employment: days in competitive employment, over one year follow-up), supported employment seems to significantly increase levels of any employment obtained during the course of studies (7 RCTs, n = 951, RR 3.24 CI 2.17 to 4.82, very low quality of evidence). Supported employment also seems to increase length of competitive employment when compared with other vocational approaches (1 RCT, n = 204, MD 70.63 CI 43.22 to 94.04, very low quality evidence). Supported employment also showed some advantages in other secondary outcomes. It appears to increase length (in days) of any form of paid employment (2 RCTs, n = 510, MD 84.94 CI 51.99 to 117.89, very low quality evidence) and job tenure (weeks) for competitive employment (1 RCT, n = 204, MD 9.86 CI 5.36 to 14.36, very low quality evidence) and any paid employment (3 RCTs, n = 735, MD 3.86 CI -2.94 to 22.17, very low quality evidence). Furthermore, one study indicated a decreased time to first competitive employment in the long term for people in supported employment (1 RCT, n = 204, MD -161.60 CI -225.73 to -97.47, very low quality evidence). A large amount of data were considerably skewed, and therefore not included in meta-analysis, which makes any meaningful interpretation of the vast amount of data very difficult. AUTHORS' CONCLUSIONS The limited available evidence suggests that supported employment is effective in improving a number of vocational outcomes relevant to people with severe mental illness, though there appears to exist some overall risk of bias in terms of the quality of individual studies. All studies should report a standard set of vocational and non-vocational outcomes that are relevant to the consumers and policy-makers. Studies with longer follow-up should be conducted to answer or address the critical question about durability of effects.
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Affiliation(s)
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine / School of Public HealthDepartments of Health Promotion and Behavior Change and of Clinical EpidemiologyYoshida Konoe‐cho, Sakyo‐ku,KyotoJapan601‐8501
| | | | - Mina Honyashiki
- Kyoto University Graduate School of Medicine / School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan601‐8501
| | - Ichiro M Omori
- Toyokawa City HospitalDepartment of PsychiatryKoumei 1‐19ToyokawaAichiJapan442‐8561
| | - Max Marshall
- The Lantern CentreUniversity of ManchesterVicarage LaneOf Watling Street Road, FulwoodPreston.LancashireUK
| | - Gary R Bond
- Dartmouth Medical SchoolDepartment of PsychiatryRivermill Commercial Centre85 Mechanic StreetLebanonNew HampshireUSA03766
| | - Peter Huxley
- University of SwanseaApplied Social StudiesVivian BuildingSingleton ParkSwanseaUKSA2 8PP
| | - Naoji Amano
- Shinshu University, School of MedicineDepartment of PsychiatryMatsumotoJapan
| | - David Kingdon
- University of SouthamptonMental Health GroupCollege Keep4‐12 Terminus TerraceSouthamptonUKSO14 3DT
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Viering S, Bärtsch B, Obermann C, Rüsch N, Rössler W, Kawohl W. The effectiveness of individual placement and support for people with mental illness new on social benefits: a study protocol. BMC Psychiatry 2013; 13:195. [PMID: 23883137 PMCID: PMC3750223 DOI: 10.1186/1471-244x-13-195] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 06/07/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Switzerland, people with a severe mental illness and unable to work receive disability benefits ('IV-pension'). Once they are granted these benefits, the chances to regain competitive employment are usually small. However, previous studies have shown that individual placement and support (IPS) supports a successful reintegration into competitive employment. This study focuses on the integration of newly appointed IV-pensioners, who have received an IV-pension for less than a year. METHOD/DESIGN The present pilot project ZHEPP (Zürcher Eingliederungs-Pilot Projekt; engl.: Zurich integration pilot project) is a randomized controlled trial (RCT). The 250 participants will be randomized to either the intervention or the control group. The intervention group receives support of a job coach according to the approach of IPS. Participants in the control group do not receive IPS support. Participation takes a total of two years for each participant. Each group is interviewed every six months (T0-T4). A two-factor analysis of variance will be conducted with the two factors group (intervention versus control group) and outcome (employment yes/no). The main criterion of the two-factor analysis will be the number of competitive employment contracts in each group. DISCUSSION This study will focus on the impact of IPS on new IV-pensioners and aims to identify predictors for a successful integration. Furthermore, we will examine the effect of IPS on stigma variables and recovery orientation. TRIAL REGISTRATION ISRCTN54951166.
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Affiliation(s)
- Sandra Viering
- University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Bettina Bärtsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Caitriona Obermann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Nicolas Rüsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Wulf Rössler
- University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital for Psychiatry, Militärstrasse 8, 8021, Zurich, Switzerland
- University of Zurich, Militärstrasse 8, 8021, Zurich, Switzerland
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Mueller DR, Schmidt SJ, Roder V. Integrated psychological therapy: effectiveness in schizophrenia inpatient settings related to patients' age. Am J Geriatr Psychiatry 2013; 21:231-41. [PMID: 23395190 DOI: 10.1016/j.jagp.2012.12.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 08/28/2011] [Accepted: 10/20/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Elderly people with schizophrenia often suffer from cognitive impairments, which affect their social functioning. Today, only a few therapy approaches for middle-aged and older patients are available. The Integrated Psychological Therapy (IPT) combines neurocognitive and social cognitive interventions with social skills approaches. The aim of this study was to evaluate (1) whether IPT is effective in younger patients (age < 40 years) and middle-aged patients (age ≥ 40 years) and (2) whether control conditions (treatment as usual or unspecific group activities) reveal some change in outcome depending on age. METHOD A total of 15 controlled IPT studies with 632 inpatients with schizophrenia were evaluated in a standard meta-analytic procedure. Studies were categorized into two age categories. RESULTS Significant medium to large effect sizes (ES) were evident for IPT independent of age on the global cognitive score (mean score of all cognitive variables), on neurocognition, social cognition, social functioning, psychopathology, and the global therapy effect (mean of all variables). The IPT effects in middle-aged patients were significantly larger on the global cognitive score, on neurocognition, and on social cognition compared with younger patients. Opposite results could be observed in control conditions. Only younger patients participating in the control conditions showed small but significant ES on these variables, but almost middle-aged control patients did not. However, none of the differences in the control conditions were significant between the two age categories. A moderator analysis obtained no evidence for a strong impact of IPT variations, therapy setting, patient characteristics, and methodologic rigor of the research design. CONCLUSIONS These results support evidence for the efficacy of IPT independent of age. Results further indicate the need of goal-oriented specific psychological interventions for middle-aged and older patients with schizophrenia.
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Affiliation(s)
- Daniel R Mueller
- University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
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Twamley EW, Vella L, Burton CZ, Becker DR, Bell MD, Jeste DV. The efficacy of supported employment for middle-aged and older people with schizophrenia. Schizophr Res 2012; 135:100-4. [PMID: 22197080 PMCID: PMC3288765 DOI: 10.1016/j.schres.2011.11.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Revised: 11/29/2011] [Accepted: 11/30/2011] [Indexed: 10/14/2022]
Abstract
OBJECTIVE Supported employment is the evidence-based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment, but few supported employment programs specifically target older clients with psychiatric illness. The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia. METHOD Participants included 58 outpatients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic. Participants were randomly assigned to receive Individual Placement and Support (IPS; the manualized version of supported employment) or conventional vocational rehabilitation (CVR) for one year, and completed assessments at baseline, six months, and twelve months. RESULTS IPS was superior to CVR on nearly all work outcome measures, including attainment of competitive employment, weeks worked, and wages earned. Fifty-seven percent of IPS participants worked competitively, compared with 29% of CVR participants; 70% of IPS participants obtained any paid work, compared with 36% of CVR participants. Within the IPS group, better baseline functional capacity (as measured by the UCSD Performance Based Skills Assessment) and more recent employment were modestly associated with better work outcomes. CONCLUSIONS Middle-aged and older adults with schizophrenia are good candidates for supported employment services.
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Affiliation(s)
- Elizabeth W. Twamley
- Department of Psychiatry and Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive (0851), La Jolla, CA, 92093, USA. ;
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Lea Vella
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA. ;
| | - Cynthia Z. Burton
- SDSU/UCSD Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 103, San Diego, CA, 92120, USA. ;
| | - Deborah R. Becker
- Dartmouth Psychiatric Research Center, 85 Mechanic Street, Suite B4-1, Lebanon, NH, 03766, USA.
| | - Morris D. Bell
- Department of Psychiatry, Yale University, 300 George Street, Suite 901, New Haven, CT, 06511, USA.
- VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA
| | - Dilip V. Jeste
- Department of Psychiatry and Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive (0851), La Jolla, CA, 92093, USA. ;
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Kukla M, Bond GR, Xie H. A prospective investigation of work and nonvocational outcomes in adults with severe mental illness. J Nerv Ment Dis 2012; 200:214-22. [PMID: 22373758 DOI: 10.1097/nmd.0b013e318247cb29] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This study assessed the impact of steady competitive or noncompetitive employment on nonvocational outcomes for clients with severe mental illness receiving employment services. We conducted a secondary analysis of 2-year data for 187 clients participating in a randomized controlled trial comparing two employment programs. Participants were classified according to 2-year employment outcomes into four groups: steady competitive work, steady noncompetitive work, minimal work, and no work. We compared these groups on 2-year outcomes including symptoms, hospitalizations, quality of life, and social networks. During follow-up, working clients had fewer days of hospitalization than the no-work group. The steady competitive group had greater reduction in negative symptoms than did the no-work group. The steady noncompetitive group showed greater improvement in social networks compared with the other groups. Extended periods of work are associated with improvements in nonvocational outcomes. Beneficial effects may vary according to the type of employment.
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Affiliation(s)
- Marina Kukla
- HSR&D Center of Excellence on Implementing Evidence-Based Practice, Richard L.Roudebush VA Medical Center, Indianapolis, IN 46202, USA.
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Abstract
BACKGROUND Schizophrenia is usually considered an illness of young adulthood. However, onset after the age of 40 years is reported in 23% of patients hospitalised with schizophrenia. At least 0.1% of the world's elderly population have a diagnosis of late-onset schizophrenia which seems to differ from earlier onset schizophrenia on a variety of counts including response to antipsychotic drugs. OBJECTIVES To assess the effects of antipsychotic drugs for elderly people with late-onset schizophrenia. SEARCH METHODS We searched the Cochrane Schizophrenia Group Trials Register (January 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected references of all identified studies for further trials. We contacted relevant authors of trials for additional information. SELECTION CRITERIA All relevant randomised controlled trials that compared antipsychotic drugs with other treatments for elderly people (at least 80% older than 65 years) with a recent (within five years) diagnosis of schizophrenia or schizophrenia like illnesses. DATA COLLECTION AND ANALYSIS For the 2010 search, two new review authors (AE, AG) inspected all citations to ensure reliable selection. We assessed methodological quality of trials using the criteria recommended in the Cochrane Handbook for Systematic Reviews of Interventions. AE and AG also independently extracted data. For homogenous dichotomous data, we planned to calculate the relative risk (RR) and 95% confidence interval (CI). MAIN RESULTS There were no included studies in the original version of this review (2002 search). The 2010 search for the current update produced 211 references, among which we identified 88 studies. Only one study met the inclusion criteria and was of acceptable quality. This was an eight-week randomised trial of risperidone and olanzapine in 44 inpatients with late-onset schizophrenia. All participants completed the eight-week trial, indicating that both drugs were well tolerated. Unfortunately, this study provided little usable data. We excluded a total of 81 studies, 77 studies because they either studied interventions other than antipsychotic medication or because they involved elderly people with chronic - not late-onset - schizophrenia. We excluded a further four trials of antipsychotics in late-onset schizophrenia because of flawed design. Five studies are still awaiting classification, and one is on-going. AUTHORS' CONCLUSIONS There is no trial-based evidence upon which to base guidelines for the treatment of late-onset schizophrenia. There is a need for good quality-controlled clinical trials into the effects of antipsychotics for this group. Such trials are possible. Until they are undertaken, people with late-onset schizophrenia will be treated by doctors using clinical judgement and habit to guide prescribing.
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Affiliation(s)
- Adib Essali
- Psychiatry Centre, Teshreen Hospital, Damascus, Syrian Arab Republic.
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Bond GR, Drake RE, Becker DR. Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US. World Psychiatry 2012; 11:32-9. [PMID: 22295007 PMCID: PMC3266767 DOI: 10.1016/j.wpsyc.2012.01.005] [Citation(s) in RCA: 209] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
While reviews of controlled studies of the Individual Placement and Support (IPS) model of supported employment for clients with severe mental illness have documented its effectiveness in the US, its generalizability to other countries has not been systematically evaluated. This is the first review to compare US to non-US studies. We identified 15 randomized controlled trials of IPS programs, 9 in the US and 6 outside the US. We examined competitive employment outcomes, including employment rate, days to first job, weeks worked during follow-up, and hours worked. We also considered noncompetitive employment, program retention, and nonvocational outcomes. IPS programs had significantly better outcomes across a range of competitive employment indicators and higher retention in services than control groups. The overall competitive employment rate for IPS clients in US studies was significantly higher than in non-US studies (62% vs. 47%). The consistently positive competitive employment outcomes strongly favoring IPS over a range of comparison programs in a group of international studies suggest that IPS is an evidence-based practice that may transport well into new settings as long as programs achieve high fidelity to the IPS model, but further research is needed on international adaptations.
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Affiliation(s)
- Gary R Bond
- Dartmouth Psychiatric Research Center, Rivermill Commercial Center, 85 Mechanic Street, Lebanon, NH 03766, USA
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Chou HH, Twamley E, Swerdlow NR. Towards medication-enhancement of cognitive interventions in schizophrenia. Handb Exp Pharmacol 2012:81-111. [PMID: 23027413 PMCID: PMC3629915 DOI: 10.1007/978-3-642-25758-2_4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Current antipsychotic medications do little to improve real-life function in most schizophrenia patients. A dispassionate view of the dispersed and variable neuropathology of schizophrenia strongly suggests that it is not currently, and may never be, correctable with drugs. In contrast, several forms of cognitive therapy have been demonstrated to have modest but lasting positive effects on cognition, symptoms, and functional outcomes in schizophrenia patients. To date, attempts to improve clinical outcomes in schizophrenia by adding pro-cognitive drugs to antipsychotic regimens have had limited success, but we propose that a more promising strategy would be to pair drugs that enhance specific neurocognitive functions with cognitive therapies that challenge and reinforce those functions. By using medications that engage spared neural resources in the service of cognitive interventions, it might be possible to significantly enhance the efficacy of cognitive therapies. We review and suggest several laboratory measures that might detect potential pro-neurocognitive effects of drugs in individual patients, using a "test dose" design, aided by specific biomarkers predicting an individual's drug sensitivity. Lastly, we argue that drug classes viewed as "counter-intuitive" based on existing models for the pathophysiology of schizophrenia-including pro-catecholaminergic and NMDA-antagonistic drugs-might be important candidate "pro-cognitive therapy" drugs.
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Affiliation(s)
- Hsun-Hua Chou
- Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0804, USA
| | - Elizabeth Twamley
- Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0804, USA
| | - Neal R. Swerdlow
- Department of Psychiatry, School of Medicine, University of California, San Diego, 9500 Gilman Dr., La Jolla, CA 92093-0804, USA
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HESLIN MARGARET, HOWARD LOUISE, LEESE MORVEN, McCRONE PAUL, RICE CHRISTOPHER, JARRETT MANUELA, SPOKES TERRY, HUXLEY PETER, THORNICROFT GRAHAM. Randomized controlled trial of supported employment in England: 2 year follow-up of the Supported Work and Needs (SWAN) study. World Psychiatry 2011; 10:132-7. [PMID: 21633690 PMCID: PMC3105475 DOI: 10.1002/j.2051-5545.2011.tb00035.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Studies from North America have concluded that supported employment using the Individual Placement and Support (IPS) model is effective in helping individuals with severe and persistent mental illness gain competitive employment. The aim of this study was to investigate the effectiveness and cost-effectiveness of IPS in England in patients followed up for 2 years. Patients with severe mental illness were randomised to IPS or local vocational services (treatment as usual). Service use and costs were measured. Two hundred-nineteen participants were randomised, and 86% re-assessed 2 years later. In the multivariate analysis, relatively low rates of competitive employment were found in both the intervention group and the treatment as usual group, although significantly more patients obtained competitive employment in the treatment arm (22% vs. 11%, p=0.041). There were no significant differences in costs. The employment rate among participants receiving IPS was lower than in previously published reports, and the number needed to treat to obtain the benefit of IPS was relatively high. This may reflect difficulties in the implementation of IPS where it is not structurally integrated within mental health teams, as well as economic disincentives which lead to lower levels of motivation for patients and mental health professionals.
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Affiliation(s)
- MARGARET HESLIN
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - LOUISE HOWARD
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK,Biomedical Research Centre for Mental Health, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
| | - MORVEN LEESE
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - PAUL McCRONE
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - CHRISTOPHER RICE
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - MANUELA JARRETT
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - TERRY SPOKES
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - PETER HUXLEY
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK
| | - GRAHAM THORNICROFT
- Health Service and Population Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK,Biomedical Research Centre for Mental Health, National Institute for Health Research, South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
Psychosis is common in late-life and exacts enormous costs to society, affected individuals, and their caregivers. A multitude of etiologies for late-life psychosis exist, the two most prototypical being schizophrenia and psychosis of Alzheimer disease (AD). As such, this article focuses on the nonaffective, neuropsychiatric causes of chronic psychosis in the elderly, specifically schizophrenia, delusional disorder, and the psychosis of AD and other dementias.
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Nygren U, Markström U, Svensson B, Hansson L, Sandlund M. Individual placement and support - a model to get employed for people with mental illness - the first Swedish report of outcomes. Scand J Caring Sci 2011; 25:591-8. [DOI: 10.1111/j.1471-6712.2011.00869.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
OBJECTIVE There are significant mental health benefits in schizophrenia associated with integration into society and the workplace. This case examines factors contributing to such reintegration. CONCLUSIONS A hostel team, an employment officer from an employment agency for the disabled and a community clinic collaborated to foster reintegration into the community through supported employment, improved supported accommodation and family support.
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Affiliation(s)
- Ann Solar
- Department of Psychiatry, Sir Charles Gairdner Hospital and Subiaco Community Mental Health Clinic, Perth, WA, Australia.
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Kurzban S, Davis L, Brekke JS. Vocational, social, and cognitive rehabilitation for individuals diagnosed with schizophrenia: a review of recent research and trends. Curr Psychiatry Rep 2010; 12:345-55. [PMID: 20574811 DOI: 10.1007/s11920-010-0129-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A growing body of evidence suggests that social and vocational interventions effectively enhance social and vocational functioning for individuals with schizophrenia. In this review, we first consider recent advances in vocational and social rehabilitation, then examine current findings on neurocognition, social cognition, and motivation with regard to the impact these elements have on rehabilitation interventions and outcomes. A critical evaluation of recent studies examining standalone treatment approaches and hybrid approaches that integrate components such as cognitive remediation and skills training reveals several ongoing challenges within the field. Greater understanding of the differential impact of various approaches, methods that may increase the magnitude of treatment effects, and the generalization of treatment effects to community functioning are among crucial areas for future research. Overall, these treatments hold promise in improving psychosocial functioning and helping individuals with schizophrenia acquire important life skills.
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Affiliation(s)
- Seth Kurzban
- School of Social Work, University of Southern California, University Park-MC0411, Los Angeles, CA 90089, USA
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Huang XY, Lin MJ, Yang TC, Hsu YS. The functions of hospital-based home care for people with severe mental illness in Taiwan. J Clin Nurs 2010; 19:368-79. [DOI: 10.1111/j.1365-2702.2009.03052.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ottomanelli L, Lind L. Review of critical factors related to employment after spinal cord injury: implications for research and vocational services. J Spinal Cord Med 2009; 32:503-31. [PMID: 20025147 PMCID: PMC2792457 DOI: 10.1080/10790268.2009.11754553] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Employment rates after spinal cord injury (SCI) vary widely because of discrepancies in studies' definition of employment and time of measurement. The objective of this study was to provide a comprehensive summary of the literature on employment rates, predictors of employment, and the benefits and barriers involved. METHODS A search using the terms spinal cord injury and employment in the databases PubMed, PsycINFO, and MEDLINE. The search included a review of published manuscripts from 1978 through 2008. RESULTS A total of 579 articles were found and reviewed to determine the presence of reported employment rates. Of these, 60 articles were found to include a report of employment rates for individuals with SCI. Results indicated that, in studies that examined paid employment, the average rate of any employment after SCI was approximately 35%. CONCLUSIONS Characteristics associated with employment after SCI include demographic variables, injury-related factors, employment history, psychosocial issues, and disability benefit status. It is recommended that researchers studying employment after SCI use common outcome measures such as competitive employment rates, duration of employment, and job tenure. Empirical evidence is lacking in regard to the most effective methods of vocational rehabilitation among this population. Evidence-based supported employment practices seem to be the most applicable model for assisting persons with SCI in restoring meaningful employment. Controlled studies are needed to test this assumption.
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Affiliation(s)
- Lisa Ottomanelli
- Department of Psychology, VA North Texas Health Care System, 4500 S. Lancaster Road (128), Dallas, TX 75216, USA.
| | - Lisa Lind
- University of Texas Southwestern Medical School, Dallas, Texas
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Macias C, Gold PB, Hargreaves WA, Aronson E, Bickman L, Barreira PJ, Jones DR, Rodican CF, Fisher WH. Preference in random assignment: implications for the interpretation of randomized trials. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2009; 36:331-42. [PMID: 19434489 PMCID: PMC2796239 DOI: 10.1007/s10488-009-0224-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2008] [Accepted: 04/23/2009] [Indexed: 11/28/2022]
Abstract
Random assignment to a preferred experimental condition can increase service engagement and enhance outcomes, while assignment to a less-preferred condition can discourage service receipt and limit outcome attainment. We examined randomized trials for one prominent psychiatric rehabilitation intervention, supported employment, to gauge how often assignment preference might have complicated the interpretation of findings. Condition descriptions, and greater early attrition from services-as-usual comparison conditions, suggest that many study enrollees favored assignment to new rapid-job-placement supported employment, but no study took this possibility into account. Reviews of trials in other service fields are needed to determine whether this design problem is widespread.
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Affiliation(s)
- Cathaleene Macias
- Community Intervention Research, McLean Hospital, Belmont, MA 02478, USA,
| | - Paul B. Gold
- Department of Counseling and Personnel Services, University of Maryland, College Park, MD 20742, USA,
| | | | - Elliot Aronson
- Department of Psychology, University of California, Santa Cruz, CA, USA,
| | - Leonard Bickman
- Center for Evaluation and Program Improvement, Vanderbilt University, Nashville, TN, USA,
| | - Paul J. Barreira
- Harvard University Health Services, Harvard University, Boston, MA, USA,
| | - Danson R. Jones
- Institutional Research, Wharton County Junior College, Wharton, TX 77488, USA,
| | - Charles F. Rodican
- Community Intervention Research, McLean Hospital, Belmont, MA 02478, USA,
| | - William H. Fisher
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA,
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Psychosocial rehabilitation and quality of life for older adults with serious mental illness: recent findings and future research directions. Curr Opin Psychiatry 2009; 22:381-5. [PMID: 19417666 PMCID: PMC3163501 DOI: 10.1097/yco.0b013e32832c9234] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The projected increase of Americans aged 65 years and older will have an unprecedented impact on the healthcare delivery system. As a result, new models to support individuals with serious mental illness (SMI) will become increasingly more important. This selective overview highlights recent reports addressing psychosocial functioning and interventions for older adults with SMI. RECENT FINDINGS Recently published descriptive studies suggest that poor functional outcomes and lower quality of life among older people with SMI are strongly associated with social isolation, depression, cognitive impairment, and chronic medical illness. Recent research on psychosocial interventions includes evaluations of three different models of skills training, a supported employment intervention, and cognitive remediation. This research establishes psychosocial rehabilitation as feasible and potentially effective in improving functioning and quality of life in older adults with SMI. SUMMARY Several important directions for future research focused on older adults with SMI are suggested by this overview. They include individually tailored rehabilitation, interventions that optimize social integration and decrease depressive symptoms, techniques that blend cognitive remediation with vocational rehabilitation, and integration of health promotion with psychosocial rehabilitation.
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Abstract
PURPOSE OF REVIEW Recently published studies examining predictors of competitive employment for patients with schizophrenia are reviewed. RECENT FINDINGS Researchers continue to examine predictors of employment among three types of variables: patient characteristics, environmental factors, and interventions. Provision of supported employment is the strongest predictor of competitive employment in this population, while patient predictors continue to show modest associations with outcomes. Environmental factors, including societal and cultural influence, local economy, labor laws, disability policies, and governmental regulations, are presumed to have major influences on employment, but these factors have been little studied. SUMMARY Given the strong and consistent evidence base for the effectiveness of supported employment in helping individuals with schizophrenia achieve competitive employment, mental health planners should make access to this practice a high priority. Barriers to implementation of supported employment, including finance, organization, integration, training, and supervision, need to be systematically addressed. The field currently lacks an adequate understanding of the role of societal, cultural, and regulatory factors in facilitating and hindering employment outcomes; such research is much needed.
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PRATT SARAHI, VAN CITTERS ARICCAD, MUESER KIMT, BARTELS STEPHENJ. Psychosocial Rehabilitation in Older Adults with Serious Mental Illness: A Review of the Research Literature and Recommendations for Development of Rehabilitative Approaches. AMERICAN JOURNAL OF PSYCHIATRIC REHABILITATION 2008. [DOI: 10.1080/15487760701853276] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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