Long-term employment among people at ultra-high risk for psychosis

Abstract

Word count abstract: 250Word count paper: 2,894 Number of tables: 2Supplementary data: Supplementary Table 1 2 Abstract BackgroundPsychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultrahigh risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort. Method UHR patients recruited from the Personal Assessment and Crisis Evaluationclinic in Melbourne, Australia were followed-up over 2-14 years after initial presentation to the service. Individuals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome. ResultsA high rate of unemployment was present at follow-up in this UHR sample (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed individuals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses.3 ConclusionsNearly a quarter of this UHR sample were unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.

Early intervention for everyone? A review of cross‐cultural issues and their treatment in ultra‐high‐risk (UHR) cohorts

“…Three studies explored the presence of psychiatric comorbidities and their associations with clinical and functional outcomes in subjects at UHR (Fusar‐Poli et al, ; Lim et al, ; Rutigliano et al, ). Nine other studies analysed the association between psychosocial (Cotter et al, ; O'Donoghue et al, ; A. Thompson et al, ), environmental (Pawełczyk, Trafalska, Kotlicka‐Antczak, & Pawełczyk, ; Valmaggia et al, ), trauma (Bechdolf et al, ; T. C. Kraan et al, ; A. Thompson et al, ) and cannabis‐related (McHugh et al, ) risk factors and the risk of conversion towards a psychotic disorder. Nelson and Yung () evaluated the predictive validity of clinic impression or the “praecox feeling” and criticized the validity of this intuitive approach.…”

“…Nine other studies analysed the association between psychosocial (Cotter et al, 2017;O'Donoghue et al, 2015; A. Thompson et al, 2013), environmental (Pawełczyk, Trafalska, Kotlicka-Antczak, & Pawełczyk, 2016;Valmaggia et al, 2014) evaluated the predictive validity of clinic impression or the "praecox feeling" and criticized the validity of this intuitive approach.…”

Psychopathology and social functioning of 42 subjects from a Danish ultra high‐risk cohort

“…). UHR subjects are less able to provide for themselves, they have lower level of education, higher rate of unemployment than an age-matched general population and more live either with parents or in communal establishments (Cotter et al, 2016;Fusar-Poli et al, 2010;Salokangas et al, 2013;Shim et al, 2008). In previous studies 67%-71% fulfil at least one comorbid diagnosis in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; Morrison et al, 2012;Rosen, Miller, D'Andrea, McGlashan, & Woods, 2006;Salokangas et al, 2012), especially within the areas of depression (30%-50%) and anxiety (8%-15%; Conrad et al, 2014;Fusar-Poli, Nelson, Valmaggia, Yung, & McGuire, 2012;Hutton, Bowe, Parker, & Ford, 2011;Lim et al, 2015) but they also meet criteria of a variety of other conditions such as substance abuse and personality disorders (Lencz et al, 2004;Morrison et al, 2012;Niendam, Berzak, Cannon, & Bearden, 2009;Rosen et al, 2006;Ryan, Graham, Nelson, & Yung, 2015).…”

Exploring functional impairment in young people at ultra‐high risk for psychosis: A qualitative study

“…This emphasises the importance of assessing traumatic childhood experiences and ongoing abuse in adulthood in individuals presenting to mental health services (Cotter, Drake, & Yung, 2016;Cotter, Kaess, & Yung, 2015;Hovens et al, 2012;Varese et al, 2012). This study and previous research in this area suggest similar approaches are warranted in the UHR group and may confer benefits for both functional and symptomatic outcomes (Cotter, Lin, et al, 2017;Kraan et al, 2017). This study and previous research in this area suggest similar approaches are warranted in the UHR group and may confer benefits for both functional and symptomatic outcomes (Cotter, Lin, et al, 2017;Kraan et al, 2017).…”

“…Functional impairments usually occur in adolescence or early adulthood, an important time in a young person's life for forming relationships, finishing education and starting a career (Velthorst et al, ). There is evidence that a large proportion of UHR individuals continue to function poorly in the long‐term regardless of symptomatic remission or transition to full‐threshold psychotic disorder (Addington et al, ; Cotter, Lin, et al, ; Schlosser et al, ). However, there is substantial variability in functional outcome in this group, suggesting a need to further investigate why some individuals continue to function poorly and others do not.…”