Cognitive Functioning and Employment in Severe Mental Illness

Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Borough of Manhattan, New York, United States
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 01/2004; 191(12):789-98. DOI: 10.1097/01.nmd.0000100921.31489.5a
Source: PubMed


This study compared cognitive functioning and symptomatology of unemployed, supported employed, and independently employed clients with severe mental illness. Unemployed clients who wanted to work (N = 21) were compared with clients working in supported employment programs (N = 17) and clients who had been working independently for at least 1 year (N = 23) on a neuropsychological battery and the Positive and Negative Syndrome Scale. Clients who were unemployed had more severe symptoms and worse cognitive functioning on both positive and negative symptoms, and almost all domains of cognitive functioning. Supported employed clients had more severe psychotic symptoms and worse working memory than independently employed clients, but did not differ in negative symptoms or the other domains of cognitive functioning, including attention/concentration, psychomotor speed, verbal learning and memory, or executive functions. Finally, job complexity was correlated with impaired executive functions among clients working independently, but not in supported employment. Severe symptoms and cognitive impairment may interfere with the ability of some clients with severe mental illness to obtain competitive work. Supported employment programs appear to work by helping clients compensate for problematic symptoms and cognitive impairment and, to a lesser extent, by finding or developing environmental niches in which these impairments do not impede their ability to perform the necessary job tasks.

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    • "Executive dysfunction is present already in the first year of the illness, even before the first contact with the public health care service (Hoff et al., 2005), and is a contributing factor to functional loss and disability. Executive functioning predicts degree of selfcare , as well as social, interpersonal, community, and occupational functioning (Mcgurk and Mueser, 2003; Bowie and Harvey, 2006), and is associated with treatment success. Impairments in this domain are coupled with less engagement in therapy, poorer medication adherence, and longer hospital stays (McKee et al., 1997; Jackson et al., 2001; Robinson et al., 2002; Bowie and Harvey , 2006). "
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    ABSTRACT: Executive functioning is a multi-dimensional construct covering several sub-processes. The aim of this study was to determine whether executive functions, indexed by a broad range of executive measures remain stable in first episode psychosis (FEP) over time. Eighty-two patients and 107 age and gender matched healthy controls were assessed on five subdomains of executive functioning; working memory, fluency, flexibility, and inhibitory control at baseline and at 1 year follow-up. Results showed that patients performed significantly poorer than controls on all executive measures at both assessment points. In general executive functions remained stable from baseline to follow-up, although both groups improved on measures of inhibitory control and flexibility. In phonemic fluency, controls showed a slight improvement while patients showed a slight decline. Investigation of individual trajectories revealed some fluctuations in both groups over time, but mainly supports the group level findings. The implications of these results are discussed. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    06/2015; 228(3). DOI:10.1016/j.psychres.2015.05.060
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    • "Because the original study examined the effectiveness of IPS among young people with first-episode psychosis, only variables included in the original study could be utilized in this secondary analysis. As such, it was not possible to investigate the predictive power of cognitive factors or the impact of a prior work history on vocational outcomes, both of which have been highlighted as significant predictors of work outcomes (Catty et al., 2008; McGurk et al., 2003). While data pertaining to prior work history was collected, it was not possible to evaluate this as a predictor in the current study because there was insufficient spread between the responses, with 34 participants reporting a work history, and only 2 participants reporting an absence of work history. "
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    ABSTRACT: Objective: The current study sought to examine demographic and clinical predictors of vocational recovery among young people with first-episode psychosis who participated in a randomized controlled trial (RCT) investigating the effectiveness of the supported employment model among this population. Method: Our original RCT compared Individual Placement and Support + treatment as usual (n = 20) with treatment as usual alone (n = 21) (Killackey, Jackson, & McGorry, 2008). A series of logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors on the vocational recovery of young people with first-episode psychosis. Results: Vocational recovery (defined as securing a position in competitive employment or attending a course of education at any point during the 6-month follow-up period) was predicted by participating in the vocational intervention (OR = 14.17, p = .001), having never been married (compared to those married/de facto: OR = 6.56, p = .044), and the instrumental role functioning subscale from the Quality of Life scale (OR = 1.21, p = .037). When considered together, only treatment group remained significant: Participants randomized to the vocational intervention were 16.26 times more likely to obtain work or study during the follow-up period compared to participants randomized to treatment as usual. Conclusions and implications for practice: It is critical that vocational services are introduced as part of an evidence-based, multidisciplinary approach in routine clinical care at early psychosis services. Further replication of these findings is indicated with a larger sample, particularly with the addition of cognitive training interventions to further improve vocational outcomes for young people with first-episode psychosis.
    Psychiatric Rehabilitation Journal 12/2012; 35(6):421-427. DOI:10.1037/h0094574 · 1.16 Impact Factor
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    • "Previous work history was also found as a predictor of employment [13] [19]. Vocational training is found to be related to employment status in some studies [11] [15] [22], yet in some studies no relation was found [7]. In addition, the patients who have more friends and receive more social support display a greater rate of full-time employment [6]. "
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    ABSTRACT: The aim of this study is to investigate the relationship between work/study status and symptom severity, functionality and quality of life (QoL) in schizophrenia patients. Two-hundred and ninety-five chronic schizophrenia patients from 11 centres were included in the study. Symptom severity was measured with Positive and Negative Syndrome Scale for schizophrenia. QoL and functionality was assessed with Global Assessment of Functioning Scale, Quality of Life Scale, Personal and Social Performance Scale, Psychosocial Remission in Schizophrenia Scale, Functional Recovery Scale in Schizophrenia, Performance-Based Skills Assessment-Brief Version and Subjective Well-being under Neuroleptics Scales. Two-third of the participants (n=194) were unemployed. Forty (13.6%) of the participants were involved in full-time work/study, 29 (9.8%) people were involved in part-time work/study, 13 (4.4%) people were engaged in work/study below 50% of the time, but their job was classified as regular and independent. Those who work/study had lower symptoms, better functioning and higher levels of QoL. Also those who work/study full-time displayed better results on these measures than the participants involved in part-time work/study. Age, education, severity of negative symptoms, gender and duration of remission were found to be related to employment status in the logistic regression analysis. Our findings suggest that work/study status is an important component of functionality.
    European Psychiatry 05/2011; 27(6):422-5. DOI:10.1016/j.eurpsy.2011.01.014 · 3.44 Impact Factor
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