Impact of insight and metacognition on vocational rehabilitation of individuals with severe mental illness: A systematic review.

Abstract

Objective: Identifying specific insight and/or metacognitive measures predicting vocational outcomes would lead to a refinement of cognitive and behavioral assessment and treatment of people with severe mental illness. Methods: We conducted a systematic review of empirical research following preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Studies published in PubMed and PsycINFO from January 1, 2000 to April 30, 2020 and including words referring to "vocational outcomes", "insight," and "metacognition" were screened. Results: Twenty-eight studies were included, 19 assessing insight and 9 assessing metacognition and their relationships with vocational outcomes in patients with severe mental illness. Thirteen studies (68%) identified statistically significant relationships between insight scores and vocational outcomes. Five studies (56%) identified statistically significant relationships between metacognition scores or metacognitive training and vocational outcomes. The most common tools whose measures were significantly related to vocational outcomes were the Schedule for the Assessment of Insight, the Scale to assess Unawareness of Mental Disorder and the Metacognition Assessment Scale-Abbreviated. Conclusions and Implications for Practice: Insight and metacognition appeared to be related to the vocational outcomes of people with severe mental illness. However, due to the heterogeneity of variables used to operationalize insight, metacognition, and vocational outcomes, it was not possible to determine the overall effect of insight and metacognition. Nevertheless, assessment including the measures of insight and metacognition would be relevant in vocational rehabilitation centers and in centers providing care through employment. The literature lacks predictive models of employment variables including insight and metacognition, so further studies should address this. Impact and ImplicationsInsight and metacognitive levels of people with severe mental illness appeared to be related to their vocational outcomes. Assessment including the measures of insight and metacognition would be relevant in vocational rehabilitation centers and in centers providing care through employment. Further studies should focus on possible predictive relationships between insight/metacognition and the ability to (return to) work of people with severe mental illness.