Rates and correlates of employment in people with schizophrenia in the UK, France and Germany

Marwaha, Steven; Johnson, Sonia; Bebbington, Paul; Stafford, Mai; Angermeyer, Matthias C.; Brugha, Traolach; Azorin, Jean‐Michel; Kilian, Reinhold; Hansen, Karina; Toumi, Mondher

doi:10.1192/bjp.bp.105.020982

Cited by 307 publications

(235 citation statements)

References 24 publications

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“…Although this is a much lower figure compared to the unemployment rate reported in individuals with full-threshold psychotic disorders both in Australia and internationally (Marwaha et al, 2007;Waghorn et al, 2012), it is still a considerable proportion of young people and represents a potential target for intervention. Childhood trauma and longer DUI were significant independent predictors of employment status at follow-up in the multivariate analyses.…”

Section: Summary Of Resultsmentioning

confidence: 73%

“…Psychotic disorders such as schizophrenia are associated with high rates of sustained unemployment (Marwaha and Johnson, 2004;Marwaha et al, 2007;Waghorn et al, 2012). In an effort to reduce this, there is a growing international consensus that vocational support should be offered for these patients (Kreyenbuhl et al, 2010;National Institute for Health and Care Excellence, 2014;Galletly et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

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

Cotter

Lin

Drake

et al. 2017

Schizophrenia Research

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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.

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Section: Summary Of Resultsmentioning

confidence: 73%

Section: Introductionmentioning

confidence: 99%

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

Cotter

Lin

Drake

et al. 2017

Schizophrenia Research

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“…We used the European Schizophrenia Cohort (EuroSC) – a naturalistic 2-year follow-up of a cohort of 1,208 European schizophrenia patients [14]. Indeed, the EuroSC cohort has been extensively used in past research, which focused on investigating treatment efficacy [15], patients’ quality of life [16–18], employment [19], social contact [20,21] and subjective feelings of security and safety [22], as well as assessing caregiver burden [23] and quantifying direct health care costs associated with managing the disease [24,25]. …”

Section: Introductionmentioning

confidence: 99%

Healthcare resource use in schizophrenia, EuroSC findings

Millier

Horváth

Kóczián

et al. 2017

Journal of Market Access & Health Policy

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Background: It is unclear if the burden associated with schizophrenia is affected by the type and severity of patient’s symptoms. Objective: This study aims to quantify healthcare resource use associated with different profiles of schizophrenia symptoms. Study design: Post-hoc analysis of data from a naturalistic follow-up study. Setting: Secondary psychiatric services in France, Germany and the UK. Patients: EuroSC cohort:, representative sample of 1,208 schizophrenia patients Main outcome measure: We classified patients into eight health states, according to the Lenert classification (HS1–HS8), and estimated 6-month healthcare resource use (outpatient and day clinic visits, and hospitalisations) across the health states. Results: Approximately half of the patients were classed as having mild symptoms (HS1), with around 20% experiencing moderate, predominantly negative symptoms (HS2). The remaining health states were represented by <10% of patients each. Very few patients experienced extremely severe symptoms (HS8). No health state was associated with excess utilisation across all resource types. In terms of outpatient visits, patients were estimated to see a psychiatrist most often (3.01–4.15 visits over 6 months). Hospital admission was needed in 11%(HS1) – 35%(HS8) of patients and inpatient stays were generally prolonged for all health states (39–57 days). The average number of inpatient days was highest for patients in HS8 (18.17 days), followed by patients with severe negative symptoms (HS4; 13.37 days). In other health states characterised by severe symptoms (HS5–HS7), the average number of inpatient days was approximately half of those seen for HS4 (6.09–7.66). Conclusion: While none of the symptom profiles was associated with excess resource usage, hospitalization days were highest for HS with severe, predominantly negative or extremely severe symptoms. Patients with predominantly negative, moderate or severe symptoms appeared to have a high number of psychologist visits – an interesting finding that may reflect a specific therapeutic approach to the treatment of these patients.

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“…In fact, the literature indicates that employment rates for people with schizophrenia are much lower than in the general population, ranging between 14.5-17.2% in the United States (USA) [2,3] and 11.5% in France, 12.9% in the United Kingdom (UK) and 30.3% in Germany [4], placing people with schizophrenia among those disability groups that are highly likely to be unemployed [5]. These findings mean that the schizophrenia has a considerable economic burden on families and health systems; they also suggest that people with schizophrenia do not enjoy the multiple benefits of paid employment, which are widely documented.…”

Section: Introductionmentioning

confidence: 99%

Employment outcomes for people with schizophrenia spectrum disorder: A meta-analysis of randomized controlled trials

Carmona

Gómez-Benito

Huedo‐Medina

et al. 2017

Int J Occup Med Environ Health

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Access to employment plays a critical role in the recovery and functioning of people with schizophrenia. We have investigated the effectiveness of treatments to enhance employment outcomes for people with schizophrenia and evaluated the potential moderators of these outcomes. A literature search was conducted in CINAHL, Cochrane Databases, MED-LINE, ProQuest XML, PsycINFO, Scopus, and Web of Science. Grey literature databases, references lists of the retrieved articles and specialized journals in the field were also inspected. Job placement, job tenure and wages earned were tested. Risk ratios were extracted for job placement and standardized mean differences were calculated for job tenure and wages earned. Twenty-five randomized controlled trials published between 1986 and December 2015 were analyzed. Engaging in a vocational intervention increases the likelihood of obtaining a competitive job (risk ratio (RR) = 2.31, 95% confidence interval (CI): 1.85-2.88) and has a positive impact on hours worked in any job (standardized mean difference (SMD) = 0.42, 95% CI: 0.16-0.68). There was no evidence of intervention efficacy with regard to wages earned from competitive employment. Participation in rehabilitative vocational treatment is not sufficient to ensure work participation for people with schizophrenia. Comprehensive treatments are necessary to address functional deficits that hinder labor stability and job performance for people with schizophrenia. Int J Occup Med Environ Health 2017;30(3):345-366

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Rates and correlates of employment in people with schizophrenia in the UK, France and Germany

Abstract: Local social contexts may be as important as individual or illness-related factors in explaining employment status.

Cited by 307 publications

References 24 publications

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

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

Healthcare resource use in schizophrenia, EuroSC findings

Employment outcomes for people with schizophrenia spectrum disorder: A meta-analysis of randomized controlled trials

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