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Mélissa B, Sabrina G, Charles-Edouard G, Hind Z, Consortium S, Kingsada P, Stéphane P, Alexandre D. Clinical characteristics associated with functioning trajectories following admission to a psychiatric institution: A prospective cohort study of individuals with psychosis. Psychiatry Res 2024; 339:116062. [PMID: 38968920 DOI: 10.1016/j.psychres.2024.116062] [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] [Received: 02/23/2024] [Revised: 05/26/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
Psychotic disorders can be severely enabling, and functional recovery is often difficult to achieve. Admission to a psychiatric unit represents a key opportunity to implement strategies that will improve functional outcomes. In the current literature, there is a lack of consensus on which factors influence functional recovery. Therefore, the present longitudinal cohort study aimed to identify factors associated with functional trajectories following hospital admission for acute psychosis. A sample of 453 individuals with acute psychosis was extracted from the Signature Biobank database. Participants were followed for up to a year following admission. Various clinical indicators were documented over time. Functional trajectories were calculated based on the World Health Organization Disability Assessment Schedule 2.0. Three groups were identified: "improving", "stable", and "worsening" function. Individuals with a more severe symptomatic presentation at baseline were found to have better functional improve more over time. Over time, individuals in the "improving" and "stable" groups had significant improvements in their psychiatric symptoms. Finally, individuals following a "worsening" functional trajectory initially improved in terms of psychotic symptoms, but it did not persist over time. These results highlight the importance of studying function as a key component of recovery rather than solely focusing on relapse prevention.
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Affiliation(s)
- Beaudoin Mélissa
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Faculty of Medicine, McGill University. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada.
| | - Giguère Sabrina
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Giguère Charles-Edouard
- Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Ziady Hind
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Signature Consortium
- Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Phraxayavong Kingsada
- Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada; Services et recherche psychiatrique AD. Montreal, QC, Canada
| | - Potvin Stéphane
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada
| | - Dumais Alexandre
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal. Montreal, QC, Canada; Research center of the Institut universitaire en santé mentale de Montréal. Montreal, QC, Canada; Services et recherche psychiatrique AD. Montreal, QC, Canada; Institut national de psychiatrie légale Philippe-Pinel. Montreal, QC, Canada.
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Zamora-Moncayo EC, Herrera B, Larrieta J, DuBois A, Miguel Esponda G. A Participatory Evaluation of an Urban Garden Project in Ecuador: Exploring Factors That Impact the Recovery of People With Severe Mental Health Problems. QUALITATIVE HEALTH RESEARCH 2024:10497323241245867. [PMID: 39030699 DOI: 10.1177/10497323241245867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2024]
Abstract
For the past years, Ecuador has been transitioning away from a hospital-based model of mental healthcare to one that is community-centred. However, challenges associated with hospital-based models endure, notably financial burden faced by those with severe mental health problems (SMHPs) due to labour market discrimination. Employment access for this group is often disregarded in policy planning, despite evidence of its benefits on mental health. Huertomanías, an urban garden initiative in Ecuador founded in 2015, works with individuals with SMHPs, providing work, income, and social inclusion. A case study using a participatory approach was carried out to explore factors that impact the recovery of people with SMHPs. Twelve participants engaged in diverse stages of the research, where several participatory activities were conducted including cognitive mapping, a photovoice project, and interviews. The analysis employed a thematic approach leading to four categories of impact within the urban garden: autonomy (financial and personal), interpersonal relations and relation with the environment, mental health, and family dynamics. A final category of impact was established encompassing external factors (family support and public policy and healthcare services) that influence recovery. Findings suggest that the urban garden promotes autonomy and active participation within society, improves mental health, and transforms family dynamics. Further, this study highlights the importance of community-based mental healthcare (CBMHC), emphasising the need of public policies and healthcare in promoting autonomy through employment and community-centred services. Lastly, the study contributes insights into recovery experiences and CBMHC benefits, informing programme development and similar initiatives in Latin America.
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Affiliation(s)
| | | | | | | | - Georgina Miguel Esponda
- SHM Foundation, London, UK
- Health Services and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
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Oude Geerdink E, Huysmans MA, van Kempen H, van Weeghel J, Motazedi E, Anema JR. Individual Placement and Support and Participatory Workplace Intervention on the Work Participation of People with Disabilities: A Randomised Controlled Trial. JOURNAL OF OCCUPATIONAL REHABILITATION 2024:10.1007/s10926-024-10219-6. [PMID: 38954248 DOI: 10.1007/s10926-024-10219-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/09/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE This study assessed the effectiveness of Individual Placement and Support (IPS), Participatory Workplace Intervention (PWI), and IPS + PWI on work participation and health of people with work disabilities. METHODS A randomised controlled 2 × 2 factorial trial with 120 clients and an 18-month follow-up was performed. Differences between IPS and no-IPS and between PWI and no-PWI were assessed using log-rank tests and Cox proportional hazards models. RESULTS In the IPS group, restricted mean survival time (RMST) for sustainable paid employment was 352 days, compared to 394 in the no-IPS group (HR = 1.47, 95% CI = 0.81-2.63). In the PWI group the RMST was 378 days, compared to 367 in the no-PWI group (HR = 0.89, 95% CI = 0.48-1.64). For the secondary outcome 'starting any paid employment, a trial placement, or education' RMST was significantly lower for the IPS group (222 days) than for the no-IPS group (335 days; HR = 1.85, 95% CI = 1.01-3.42). Mental health was significantly lower (worse) in the PWI group (difference -4.07, 95% CI = -7.93 to -0.22) than in the no-PWI group. For all other secondary outcomes, no statistically significant differences were found. CONCLUSION No statistically significant differences were observed in the duration until starting sustainable employment between IPS and no-IPS, and between PWI and no-PWI. The duration until starting any paid employment, a trial placement, or education was shorter in the IPS group than in the no-IPS group, but further research should explore whether this also increases sustainable employment in the longer term.
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Affiliation(s)
- E Oude Geerdink
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands.
| | - M A Huysmans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands
| | - H van Kempen
- Research and Statistics, City of Amsterdam, Amsterdam, The Netherlands
| | - J van Weeghel
- Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Tilburg, The Netherlands
| | - E Motazedi
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands
| | - J R Anema
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU Medical Center, Vrije Universiteit Amsterdam, Van der Boechorstraat 7, Postbus 7057, 1081 BT, Amsterdam, The Netherlands
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Andersén Å, Carpentsier B, Berglund E, Carlsson M. Healthcare professionals' perceptions of the contributions of rehabilitation coordinators to patients in Swedish psychiatric care: a qualitative descriptive study. BMC Psychiatry 2024; 24:437. [PMID: 38867196 PMCID: PMC11167818 DOI: 10.1186/s12888-024-05895-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Rehabilitation coordinators have gradually been introduced into Swedish psychiatric care to support individuals on sick leave to return-to-work or enter work. AIM To explore healthcare professionals' perspectives on the contributions a rehabilitation coordinator can make to patients in psychiatric care. MATERIALS AND METHODS A descriptive qualitative design was used, and data were collected through interviews. Twelve healthcare professionals in psychiatric care participated in individual semi-structured interviews. Data were analysed using thematic analysis. RESULTS An overarching theme evolved: "The rehabilitation coordinator promotes security and reduces stress in the vocational rehabilitation process", based on two themes: (1) "Adaptations and support based on the patient's needs" and (2) "Rehabilitation coordinator efforts as relevant for care". The themes, in turn, consist of six subthemes. CONCLUSIONS This study showed that healthcare professionals perceived employment as important for patients' health and well-being. Therefore, the rehabilitation coordination efforts were not only seen as beneficial for addressing patients' challenges and needs in managing the vocational rehabilitation process but also as an integral part of the patient's care.
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Affiliation(s)
- Åsa Andersén
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden.
| | - Beatrice Carpentsier
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden
| | - Erik Berglund
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, SE-171 77, Sweden
| | - Maria Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22 UPPSALA, Sweden
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Patmisari E, Huang Y, Orr M, Govindasamy S, Hielscher E, McLaren H. Supported employment interventions with people who have severe mental illness: Systematic mixed-methods umbrella review. PLoS One 2024; 19:e0304527. [PMID: 38838025 DOI: 10.1371/journal.pone.0304527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND/AIMS Primary and review studies show that supported employment interventions showed promise in assisting people with severe mental illness (SMI) in achieving successful employment and health-related outcomes. This umbrella review synthesises evidence from across review studies on supported employment interventions for individuals with SMI, to identify key findings and implementation challenges in relation to five key outcomes: (1) employment, (2) quality of life, (3) social functioning, (4) clinical/service utilisation, and (5) economic outcomes. METHODS A systematic search of eleven databases and registers (CINAHL, Cochrane, EmCare, JBI EBP, ProQuest, PsycINFO, PubMed, Scopus, and Web of Science, and Prospero and Campbell) was conducted to identify meta-analyses and systematic reviews on supported employment interventions for individuals with SMI, peer reviewed and published in English. Quality assessment and data extraction were performed using standardised Joanna Briggs Institute (JBI) tools. A mixed-methods synthesis approach was employed to integrate both quantitative and qualitative evidence. RESULTS The synthesis of 26 review studies primarily focused on the Individual Placement and Support (IPS) model among various supported employment interventions. Overall, combining supported employment with targeted interventions such as neurocognitive therapy and job-related social skill training showed a positive effect on employment (including job retention) and non-employment outcomes (e.g., health, quality of life, social functioning) relative to standard forms of supported employment for people with SMI. Contextual factors (intervention fidelity, settings, systemic barriers) were important considerations for intervention implementation and effectiveness. DISCUSSION Significant overlap of primary studies across 26 review studies exposed considerable variations in interpretation and conclusions drawn by authors, raising questions about their reliability. High volume of overlap reporting from the USA on IPS interventions in review studies is likely to have biased perceptions of effectiveness. There is no one-size-fits-all solution for supporting individuals with SMI in obtaining and maintaining employment. Tailoring strategies based on individual needs and circumstances appears crucial to address the complexity of mental health recovery. We propose creating centralised registries or databases to monitor primary studies included in reviews, thus avoiding redundancy. OTHER This umbrella study was registered with PROSPERO (No. CRD42023431191).
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Affiliation(s)
- Emi Patmisari
- Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Yunong Huang
- Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
| | - Mark Orr
- Flourish Australia, Sydney Olympic Park, New South Wales, Australia
| | | | - Emily Hielscher
- Flourish Australia, Sydney Olympic Park, New South Wales, Australia
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Helen McLaren
- Institute for Mental Health and Wellbeing, College of Education, Psychology and Social Work, Flinders University, Bedford Park, South Australia, Australia
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Chan DV, Doran JD. Mental health counseling is rated as most helpful by autistic adults: Service perspectives in adulthood. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:1190-1202. [PMID: 37679948 PMCID: PMC10918044 DOI: 10.1177/13623613231197446] [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] [Indexed: 09/09/2023]
Abstract
LAY ABSTRACT The number of autistic adults is growing, but there are fewer services to support them in adulthood. Many autistic adults need some support services to lead successful adult lives. We know a lot about the services autistic adults use and some of the problems with using these services, but we do not know which services are most helpful to them and how the services they use relate to how they interact with their communities. Forty autistic adults took part in a study about service use and community participation. They completed surveys, interviews, and carried a global positioning system tracker. They answered questions about which services are most helpful in adulthood, things that make it hard to use services, and what services they needed. Most participants used two services in the past 2 years, most frequently mental health and employment services. Adults who were currently seeing a mental health counselor were more likely to be working full-time and visit more locations in the community compared to those who were not seeing a counselor. Mental health services were reported as the most helpful service they received as adults, followed by employment services. We often focus on the importance of employment services after high school, but our findings show a need for both mental health and employment services for autistic adults.
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Affiliation(s)
- Dara V Chan
- University of North Carolina at Chapel Hill, USA
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van Oosten AJ, van Mens K, Blonk RWB, Burdorf A, Tiemens B. The relationship between having a job and the outcome of brief therapy in patients with common mental disorders. BMC Psychiatry 2023; 23:910. [PMID: 38053035 PMCID: PMC10698972 DOI: 10.1186/s12888-023-05418-z] [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] [Received: 09/26/2022] [Accepted: 11/28/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Previous studies have shown that being employed is associated not only with patients' health but also with the outcome of their treatment for severe mental illness. This study examined what influence employment had on improvements in mental health and functioning among patients with common mental disorders who received brief treatment and how patients' diagnosis, environmental and individual factors moderated the association between being employed and treatment outcome. METHODS The study used naturalistic data from a cohort of patients in a large mental health franchise in the Netherlands. The data were obtained from electronic registration systems, intake questionnaires and Routine Outcome Monitoring (ROM). The International Classification of Functioning, Disability and Health (ICF) framework was used to identify potential subgroups of patients. Logistic regression models were used to analyze the relationship between employment status and treatment outcome and to determine how the relationship differed among ICF subgroups of patients. RESULTS A strong relationship was found between employment status and the outcome of brief therapy for patients with common mental disorders. After potential confounding variables had been controlled, patients who were employed were 54% more likely to recover compared to unemployed patients. Two significant interactions were identified. Among patients who were 60 years of age or younger, being employed was positively related to recovery, but this relationship disappeared in patients older than 60 years. Second, among patients in all living situations there was a positive effect of being employed on recovery, but this effect did not occur among children (18+) who were living with a single parent. CONCLUSIONS Being employed was positively associated with treatment outcome among both people with a severe mental illness and those with a common mental disorder (CMD). The main strength of this study was its use of a large dataset from a nationwide franchised company. Attention to work is important not only for people with a severe mental illness, but also for people with a CMD. This means that in addition to re-integration methods that focus on people with a severe mental illness, more interventions are needed for people with a CMD.
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Affiliation(s)
- Ard J van Oosten
- Parnassia Groep, The Hague, The Netherlands.
- U-center Epen, Epen, The Netherlands.
| | | | - Roland W B Blonk
- Department of Human Resource Studies, Tilburg University, Tilburg, The Netherlands
- Optentia Research Focus Area, North-West University Vaal Triangle Campus, Vanderbijlpark, South Africa
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - Bea Tiemens
- Indigo Service Organization, Utrecht, The Netherlands
- Behavioral Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona Research, Wolfheze, The Netherlands
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Khanthavudh C, Grealish A, Tzouvara V, Huang J, Leamy M. Implementation and evaluation of recovery-oriented practice interventions for people with mental illness in Asia: An integrative review. Int J Nurs Stud 2023; 147:104591. [PMID: 37708624 DOI: 10.1016/j.ijnurstu.2023.104591] [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] [Received: 04/20/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Recovery is a process involving empowering individuals to take control of their lives and develop meaningful and purposeful life, regardless of whether their mental health symptoms persist. Recovery-oriented practice has been widely implemented, particularly in Anglophone countries, during the past two decades. Mental health recovery in Asia is also moving towards recovery-oriented practice. Little is known about how recovery-oriented interventions originating in the West have been implemented and evaluated in Asian contexts. OBJECTIVE This review aimed to identify 1) types of recovery-oriented practice interventions that have been implemented in Asia, 2) how they have been culturally adapted, 3) barriers and facilitators to implementation, and 4) how the interventions have been evaluated. DESIGN This is an integrative review. METHODS This integrative review followed Whittemore and Knafl's five-stage framework. Six electronic databases (e.g., PsycINFO, MEDLINE, Embase, CINAHL, Web of Science, and the Cochrane Library) were systematically searched from their inception to January 2022 to identify eligible studies published in English language. The key search terms included "mental illness", "recovery-oriented intervention", and "Asia". Studies reporting on implementation and evaluation of recovery-focused interventions in Asian settings were eligible. Quality assessment and narrative synthesis were subsequently undertaken. RESULTS Thirty-eight studies were included. Seven main types of recovery-oriented intervention were identified: (1) peer programmes; (2) illness management and recovery; (3) individual placement and support; (4) strength model case management; (5) clubhouse model; (6) wellness recovery action plan and (7) psychiatric advance directive, alongside several novel recovery programmes. Studies reported cultural adaptations for language, content, cultural norms, religious beliefs, family, and local context. Barriers to implementation included a poor understanding of recovery concepts and inadequate organisational resources. A range of clinical and personal recovery outcome measures were reported. CONCLUSIONS Recovery-oriented interventions are increasing in Asia, with nearly half of reviewed studies featuring cultural adaptations. However, research is geographically skewed, and more rigorously conducted studies are needed across a wider range of Asian countries. REGISTRATION This review was registered with the PROSPERO International prospective register of systematic reviews (CRD42022310049). TWEETABLE ABSTRACT Recovery-oriented practice interventions for people with mental illness are on the rise in Asia @chonmananNN.
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Affiliation(s)
- Chonmanan Khanthavudh
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom; Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Annmarie Grealish
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom; Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Vasiliki Tzouvara
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Jing Huang
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
| | - Mary Leamy
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, United Kingdom
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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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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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Adams WE, Rogers ES, McKnight L, Lynde D. Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023:10.1007/s10488-023-01267-w. [PMID: 37162603 DOI: 10.1007/s10488-023-01267-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 05/11/2023]
Abstract
Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.
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Affiliation(s)
- Wallis E Adams
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA
- Department of Sociology, California State University, East Bay, Hayward, USA
| | - E Sally Rogers
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Lauren McKnight
- Center for Psychiatric Rehabilitation at Boston University, 940 Commonwealth Avenue, Boston, MA, 02215, USA
| | - David Lynde
- Independent Mental Health Consultant, Concord, NH, USA
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12
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Matoba K, Buyo M, Odachi R, Kajiwara T, Endo Y. Recovery-oriented daily care practice for community-based mental health service consumers in Japan: A grounded theory approach. Int J Ment Health Nurs 2023; 32:854-865. [PMID: 36785907 DOI: 10.1111/inm.13128] [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: 07/21/2022] [Revised: 01/13/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
Recovery, which is a non-linear, unique process allowing mental health service consumers to live autonomously, has become a prominent concept. However, adapting recovery-oriented practice to daily care is challenging. We explored recovery-oriented practice among mental health professionals in Japan via semi-structured interviews including nurses, occupational therapists, and psychiatric social workers (17 professionals in total). Data were analysed using grounded theory. Six categories emerged. The core category was 'Continuing to adjust care to meet consumers' needs for their unique lives'. The professionals stated that they practised in accordance with the service consumers' sincere hopes based on an equitable relationship because they believed that this approach would enhance consumers' personal agency, proactive behaviour, and self-choice. Despite negative consequences, the professionals did not view the consumers' choices as 'failures' and instead helped them to find meaning in their experiences. Although the therapeutic relationship tended to be paternalistic, participants described how concrete practices helped build an equitable relationship. In recovery-oriented practice, the provision of support centred on consumer values is important, without imposing own's own values. Care practices should also be aligned with consumers' hopes, needs and goals.
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Affiliation(s)
- Kei Matoba
- Faculty of Nursing, Psychiatric and Mental Health Nursing, Kansai Medical University, Osaka, Japan
| | - Momoko Buyo
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Ryo Odachi
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomomi Kajiwara
- Graduate school of health sciences, Kobe University, Kobe, Japan
| | - Yoshimi Endo
- Graduate School of Nursing Science, Tottori College of Nursing, Tottori, Japan
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13
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Efficacy and acceptability of psychosocial interventions in schizophrenia: systematic overview and quality appraisal of the meta-analytic evidence. Mol Psychiatry 2023; 28:354-368. [PMID: 35999275 DOI: 10.1038/s41380-022-01727-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 07/21/2022] [Accepted: 07/26/2022] [Indexed: 01/11/2023]
Abstract
Psychosocial interventions are recommended in schizophrenia and first-episode psychosis/early psychosis (EP). Nevertheless, literature is heterogeneous and often contradictory. We conducted an umbrella review of (network) meta-analyses of randomized controlled trials (RCTs) comparing psychosocial interventions vs treatment as usual (TAU)/active interventions(ACTIVE)/MIXED controls. Primary outcome was total symptoms (TS); secondary outcomes were positive/negative/depressive symptoms (PS/NS/DS), cognition, functioning, relapse, hospitalization, quality of life (QoL), treatment discontinuation. Standardized mean difference (SMD)/odds ratio (OR)/risk ratio (RR) vs TAU/ACTIVE/MIXED were summarized at end-of-treatment (EoT)/follow-up (FU). Quality was rated as high/medium/low (AMSTAR-PLUS). Eighty-three meta-analyses were included (RCTs = 1246; n = 84,925). Against TAU, regarding TS, Early Intervention Services (EIS) were superior EoT/FU in EP (SMD = -0.32/-0.21), cognitive behavioral therapy (CBT) in schizophrenia EoT/FU (SMD = -0.38/-0.19). Regarding secondary outcomes, in EP, EIS were superior for all outcomes EoT except cognition, and at FU for PS/NS/QoL, specific family interventions (FI-s) prevented relapse EoT; in schizophrenia, superiority emerged EoT for CBT for PS/NS/relapse/functioning/QoL; psychoeducation (EDU)/any FI for relapse; cognitive remediation therapy (CRT) for cognition/functioning; and hallucination-focused integrative treatment for PS. Against ACTIVE, in EP, mixed family interventions (FI-m) were superior at FU regarding TS (SMD = -0.61) and for functioning/relapse among secondary outcomes. In schizophrenia, regarding TS, mindfulness and social skills training (SST) were superior EoT, CBT at FU; regarding secondary outcomes superiority emerged at EoT for computerized cognitive drill-and-practice training for PS/DS, CRT for cognition/functioning, EDU for relapse, individual placement and support (IPS) for employment; and at FU CBT for PS/NS. Against MIXED, in schizophrenia, CRT/EDU were superior for TS EoT (d = -0.14/SMD = -0.33), CRT regarding secondary outcomes EoT for DS/social functioning, both EoT/FU for NS/cognition/global functioning; compensatory cognitive interventions for PS/functioning EoT/FU and NS EoT; CBT for PS at FU, and EDU/SST for relapse EoT. In conclusion, mental health services should consider prioritizing EIS/any FI in EP and CBT/CRT/any FI/IPS for schizophrenia, but other interventions may be helpful for specific outcomes.
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14
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Bond GR, Al-Abdulmunem M, Ressler DR, Gade DM, Drake RE. A Randomized Controlled Trial of an Employment Program for Veterans Transitioning from the Military: Two-Year Outcomes. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2022; 49:1072-1083. [PMID: 35819542 PMCID: PMC9616746 DOI: 10.1007/s10488-022-01208-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Military personnel face numerous challenges transitioning from military jobs to meaningful civilian employment. Many veterans seek help finding employment, but few veteran employment programs have been rigorously studied. Transitioning veterans generally have access to Local Community Resources (LCR), which include the Veterans Health Administration vocational rehabilitation services, the state-federal Vocational Rehabilitation program, and the Department of Labor's American Job Centers. By contrast, the innovative National Career Coach Program (NCCP) offers intensive career coaching and financial incentives for working. METHODS This study used a randomized controlled design to compare the NCCP and LCR approaches for 208 transitioning service members (recent or pending transition). Researchers conducted interviews by telephone every four months for two years. Outcomes included earnings, months worked, and standardized self-report measures of health and well-being. Findings At two-year follow-up, significantly more NCCP participants had worked in paid employment than LCR participants (95% vs. 83%). NCCP participants averaged $2568 in monthly earnings compared to $1865 for LCR participants, thus averaging $16,872 more total income per participant over the two-year period. Employment outcomes significantly improved between Year 1 and Year 2. NCCP participants also reported significantly greater improvements in both physical and mental health compared to LCR participants. Average monthly earnings correlated with changes in health outcomes. CONCLUSIONS Veterans receiving multi-faceted employment services early in the transition from the military showed sustained benefit over a two-year period with increased earnings over time and improved mental and physical outcomes. Positive employment outcomes may have contributed to improved health outcomes.
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Affiliation(s)
- Gary R. Bond
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| | - Monirah Al-Abdulmunem
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| | - Daniel R. Ressler
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
| | - Daniel M. Gade
- Virginia Department of Veterans Services, Richmond, VA USA
| | - Robert E. Drake
- Social Policy and Economics Research, Westat, Rivermill Commercial Center, 85 Mechanic St., Lebanon, NH 03766 USA
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15
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Elliott M, Reuter JC. The Benefits and Challenges of Employment for Working Professionals Diagnosed with Mental Illness. Community Ment Health J 2022; 58:645-656. [PMID: 34244866 DOI: 10.1007/s10597-021-00866-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022]
Abstract
The purpose of this study is to explore how professional employment impacts mental health among people with mental illness, and how having a mental illness impacts job performance, both positively and negatively. The research is based on in-depth interview data from 56 professionals diagnosed with mental illness, and the interview transcripts are analyzed in accordance with the flexible coding model of qualitative data analysis. We find that working conditions of professional jobs pose challenges to managing symptoms of mental illness, including the pressures of responsibility and exposure to secondary trauma. However, professional employment also provides benefits such as social connections and feeling accountable. Similarly, symptoms cause problems at work like having angry outbursts, yet experience with mental illness informs job performance such as by increasing empathy with others. We use these findings to recommend new directions for research and argue for inclusion of people with mental illness in the workplace.
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Affiliation(s)
- Marta Elliott
- University of Nevada, Reno, 1664 N. Virginia St., Mail Stop 300, Reno, NV, 89557, USA.
| | - Jordan C Reuter
- University of Nevada, Reno, 1664 N. Virginia St., Mail Stop 300, Reno, NV, 89557, USA
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Yamaguchi S, Sato S, Shiozawa T, Matsunaga A, Ojio Y, Fujii C. Predictive Association of Low- and High-Fidelity Supported Employment Programs with Multiple Outcomes in a Real-World Setting: A Prospective Longitudinal Multi-site Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 49:255-266. [PMID: 34476622 PMCID: PMC8850236 DOI: 10.1007/s10488-021-01161-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The individual placement and support (IPS) model of supported employment is a leading evidence-based practice in community mental health services. In Japan, individualized supported employment that is highly informed by the philosophy of the IPS model has been implemented. While there is a body of evidence demonstrating the association between program fidelity and the proportion of participants gaining competitive employment, the association between fidelity and a wider set of vocational and individual outcomes has received limited investigation. This study aimed to assess whether high-fidelity individualized supported employment programs were superior to low-fidelity programs in terms of vocational outcomes, preferred job acquisition, and patient-reported outcome measures (PROMs). METHODS A prospective longitudinal study with 24-month follow-up analyzed 16 individualized supported employment programs. The Japanese version of the individualized Supported Employment Fidelity scale (JiSEF) was used to assess the structural quality of supported employment programs (scores: low-fidelity program, ≤ 90; high-fidelity program, ≥ 91). Job acquisition, work tenure, work earnings, job preference matching (e.g., occupation type, salary, and illness disclosure), and PROMs such as the INSPIRE and WHO-Five Well-being index were compared between groups. RESULTS There were 75 and 127 participants in the low-fidelity group (k = 6) and high-fidelity group (k = 10), respectively. The high-fidelity group demonstrated better vocational outcomes than the low-fidelity group, i.e., higher competitive job acquisition (71.7% versus 38.7%, respectively, adjusted odds ratio (aOR) = 3.6, p = 0.002), longer work tenure (adjusted mean difference = 140.8, p < 0.001), and better match for illness disclosure preference (92.6% versus 68.0%, respectively, aOR = 5.9, p = 0.003). However, we found no differences between groups in other preference matches or PROM outcomes. CONCLUSION High-fidelity individualized supported employment programs resulted in good vocational outcomes in a real-world setting. However, enhancing service quality to increase desired job acquisition and improve PROMs will be important in the future. CLINICAL TRIAL REGISTRATION UMIN000025648.
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Affiliation(s)
- Sosei Yamaguchi
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan.
| | - Sayaka Sato
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Takuma Shiozawa
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Asami Matsunaga
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Yasutaka Ojio
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
| | - Chiyo Fujii
- Department of Community Mental Health & Law, National Institute of Mental Health, National Center of Neurology and Psychiatry, 4-1-1 Ogawa-Higashi, Kodaira, Tokyo, 187-8553, Japan
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17
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Pichler EM, Stulz N, Wyder L, Heim S, Watzke B, Kawohl W. Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial. Front Psychiatry 2021; 12:709732. [PMID: 34712153 PMCID: PMC8546221 DOI: 10.3389/fpsyt.2021.709732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
People with mental illness often experience difficulties with reintegration into the workplace, although employment is known to assist these individuals in their recovery process. Traditional approaches of "first train, then place" have been recently replaced by supported employment (SE) methods that carry strategy of "first place, then train." Individual placement and support (IPS) is one of the best-studied methods of SE, which core principles are individualized assistance in rapid job search with consequent placement in a paid employment position. A considerable amount of high-quality evidence supported the superiority of IPS over conventional methods in providing improved employment rates, longer job tenure, as well as higher salaries in competitive job markets. Nonetheless, our knowledge about the IPS-mediated long-term effects is limited. This non-interventional follow-up study of a previously published randomized controlled trial (RCT) called ZhEPP aimed to understand the long-term impact of IPS after 6 years since the initial intervention. Participants from the ZhEPP trial, where 250 disability pensioners with mental illnesses were randomized into either IPS intervention group or treatment as usual group (TAU), were invited to face-to-face interviews, during which employment status, job tenure, workload, and salaries were assessed. One hundred and fourteen individuals agreed to participate in this follow-up study. Although during the first 2 years post-intervention, the IPS group had higher employment rates (40% (IPS) vs. 28% (TAU), p < 0.05 at 24 months), these differences disappeared by the time of follow-up assessments (72 months). The results indicated no substantial differences in primary outcome measures between IPS and TAU groups: employment rate (36 vs. 33%), workload (10.57 vs. 10.07 h per week), job tenure (29 vs. 28 months), and salary (20.21CHF vs. 25.02 CHF). These findings provide important insights regarding the long-term effects of IPS among individuals with mental health illnesses. Further research is required to advance the current knowledge about IPS intervention and its years-long impact.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Niklaus Stulz
- Psychiatric Services Aargau, Windisch, Switzerland.,Integrated Psychiatric Services Winterthur-Zurcher Unterland (IPW), Winterthur, Switzerland
| | - Lea Wyder
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland
| | - Simone Heim
- Psychiatric Services Aargau, Windisch, Switzerland.,Praxis Dr. Pramstaller, Uetikon am See, Switzerland
| | - Birgit Watzke
- Clinical Psychology and Psychotherapy, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Psychiatric Services Aargau, Windisch, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
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