Cognitive function and competitive employment in schizophrenia: Relative contribution of insight and psychopathology

Department of Neuroscience, Psychiatric Section, University of Turin, Via Cherasco 11, 10126 Turin, Italy.
Social Psychiatry (Impact Factor: 2.54). 03/2011; 47(4):553-61. DOI: 10.1007/s00127-011-0367-7
Source: PubMed


This study investigated the relationships among insight, psychopathology, cognitive function, and competitive employment in order to determine whether insight and/or psychopathology carried the influence of cognitive function to competitive employment.
We recruited 253 outpatients with stable schizophrenia and we further divided our sample into two groups of patients (unemployed and competitive employment subjects). Clinical and neuropsychological assessments were performed. All clinical variables significantly different between the two groups of subjects were subsequently analyzed using a binary logistic regression to assess their independent contribution to competitive employment in the two patients' groups. On the basis of the regression results two mediation analyses were performed.
Verbal memory, general psychopathology, and awareness of mental illness were significantly associated with competitive employment in our sample. Both awareness of mental illness and general psychopathology had a role in mediating the verbal memory-competitive employment relationship.
Taken together, these findings confirmed the importance of cognitive function in obtaining competitive employment. Our results also highlighted the independent role of general psychopathology and awareness of illness on occupational functioning in schizophrenia. Thus, a greater attention must be given to the systematic investigation of insight and general psychopathology in light of an amelioration of vocational functioning in stable schizophrenia.

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    • "More than just being desirable, work is considered to have many advantages for people with schizophrenia, not only in terms of financial gain, but also providing a stabilising or normalising influence, with improved general and mental health and wellbeing (Haro et al., 2011; Waddell, Burton, & Kendall, 2008) including, for example, better cognitive functioning (Christensen, 2007; Giugiario et al., 2012). In addition, it has been found that those in competitive employment were less likely to experience relapse (Schennach et al., 2012), and were more likely to achieve clinical remission compared to those who were unemployed and/or those in sheltered employment (Haro et al., 2011). "
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    ABSTRACT: BACKGROUND: Unemployment among people with schizophrenia remains high despite slight improvements in vocational rehabilitation services and attitudes towards people with mental health disorders over the years. Experts are in a good position to increase our understanding on why this group still experiences such significant barriers to employment. OBJECTIVE: Interviews explored experts' views on schizophrenia and employment; with a particular focus on individual, attitudinal and structural barriers, as well as available interventions and their outcomes. METHODS: The sample of 20 experts were recruited using theoretical sampling. The experts consisted of: employment specialists, healthcare professionals, activists from patient organisations, academics, caregivers and employers. A thematic approach was used for analysis. RESULTS: Low expectations of healthcare professionals which were often manifested as minimal recognition of employment as an outcome for people with schizophrenia as well as a “benefits trap” were identified as the strongest barriers to employment. In addition, the IPS model was identified as the most effective to support people to work, but lack of funding to implement the model nationally and concerns of poor implementation were raised by the experts. CONCLUSIONS: More research is required to examine which adaptations are needed for vocational interventions in order to implement them successfully.
    Journal of Vocational Rehabilitation 06/2014; 41(1):29-44. DOI:10.3233/JVR-140696
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    • "(Gould et al., 2013; Jaeger et al., 2006; Rosenheck et al., 2006; Verdoux et al., 2010) Additionally, cognitive impairment was linked to cooperativeness, work habits, work quality, social skills and personal presentation as measured by the Work Behavior Inventory. (Bell and Bryson, 2001) Furthermore, cognitive functioning was found to be predictive of endpoints such as vocational functioning, obtaining competitive employment and capability to work, as well as poorer work performance (Bowie et al., 2010; Evans et al., 2004; Giugiario et al., 2012; Hoffmann et al., 2003; Lysaker et al., 2002; Mausbach et al., 2011). Not all studies have supported the connection between CIAS and employment outcomes. "
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    ABSTRACT: Background The primary focus of research in schizophrenia has been on the positive symptoms, with findings that clearly establish their economic burden. More recently, research has expanded to focus on another core symptom of schizophrenia, namely cognitive impairments. While this work has established the adverse impact of cognitive impairments associated with schizophrenia (CIAS) on functional outcomes, their relationship to the economic impact of schizophrenia has not been systematically evaluated. Objective The aim of this research was to perform a systematic literature review identifying evidence that evaluates: 1) the economic impact of CIAS and its treatments, including health-state utilities, and 2) the economic evidence associated with improvements in the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery and the University of California Performance Skills Assessment (UPSA). Method A systematic search of articles published from January 1999–April 2013 was conducted. Studies reporting direct costs, indirect costs, and quality of life impacts of CIAS and costs of CIAS interventions were reviewed. Results Forty-three studies met inclusion criteria. Twenty-four focused on indirect costs (work-related outcomes) associated with cognitive impairments and 14 studies included residential status outcomes. Four studies concentrated on the direct cost of cognitive remediation therapy. Three studies reported quality of life outcomes, but none used health-state utilities. Eight studies focused on the UPSA and its relationship to community outcomes. Only two studies were cost-effectiveness analyses. Conclusions Despite the growing scientific literature relating CIAS to adverse outcomes, the translation of outcomes into economic outcomes is seldom reported. Should novel pharmacotherapies and/or psychosocial treatments require reimbursement from health authorities and/or other payers, many gaps warrant attention in order to demonstrate the economic value of these therapies.
    Schizophrenia Research: Cognition 03/2014; 1(1):e27–e33. DOI:10.1016/j.scog.2013.11.001
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    ABSTRACT: The importance of an adequate and satisfying level of functioning for the course and outcome of schizophrenia has been increasingly emphasized by researchers in recent years. Employment status is a major component of the patient's functioning and is generally believed to be essential for well-being, satisfaction in life, and a better prognosis for schizophrenia illness. This article summarizes recent relevant publications concerning the employment status of schizophrenia patients and its influence on treatment outcome. Given the significant link between employment status and outcome in schizophrenia, different influencing factors of employment are discussed, as they mirror potential treatment targets. Finally, currently available treatment strategies for the improvement of employment status are outlined.
    Current Psychiatry Reports 04/2012; 14(3):229-36. DOI:10.1007/s11920-012-0261-3 · 3.24 Impact Factor
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