Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: A naturalistic prospective cohort study

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Social Psychiatry (Impact Factor: 2.54). 04/2009; 45(1):1-8. DOI: 10.1007/s00127-009-0034-4
Source: PubMed


Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.
The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.
The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not (OR = 3.53, 95% CI = 1.25-10.00).
This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

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    • "The current findings showing baseline vocational status as independently predictive of later vocational outcomes (for both enrolment in education and employment) are consistent with previous studies (Major et al., 2010; Alvarez-Jimenez et al., 2012). In fact, during the 6- month follow-up period, participants who were studying at baseline were N 14× more likely to be enrolled in education than those not studying at baseline, and those who were employed at baseline were 5× more likely to be employed than those who were unemployed. "
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    ABSTRACT: To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU). 135 FEP participants (IPS n=69; TAU n=66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group. Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6months was predicted by enrolment in education at baseline (p=.002) and poorer visual organisation and memory (p=.024). Employment over 6months was predicted by employment at baseline (p=.041) and receiving IPS (p=.020). Better visual organisation and memory predicted total hours of paid work over 6months (p<.001). Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.
    Full-text · Article · Aug 2013 · Schizophrenia Research
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    • "Only one study to date, to the knowledge of the authors, has sought to explicate other factors that may be associated with vocational outcomes in early psychosis. In a study of 114 young people with first-episode psychosis, Major and colleagues (2010) found that in addition to access to a specialist vocational intervention predicting vocational recovery (defined as participation in competitive employment or an educational activity at any point during a 12-month follow-up period), recovery was also independently predicted by demographic and illness-related variables. Specifically, education beyond the secondary level, being occupied at baseline, and having a shorter duration of untreated psychosis made significant contributions to vocational recovery. "
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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.
    Full-text · Article · Dec 2012 · Psychiatric Rehabilitation Journal
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    • "They attribute this to a protective role played by FEP programs . Major et al. [5] observed a decrease in unemployment among FEP clients after 12 months even in the absence of a vocational focus. However, there is less evidence regarding the long-run outcomes for FEP programs versus usual care. "
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    ABSTRACT: Schizophrenia is one of the most debilitating mental disorders. For a significant portion of individuals who suffer from this disorder, onset occurs in young adulthood, arresting important social and educational development that is necessary for future successful labor force participation. The purpose of this paper is to contribute to the literature about clients enrolled in first episode psychosis programs and psychosocial outcomes by examining the factors associated with paid employment among young adults who have experienced their first psychotic episodes. In this paper, we consider the association of socioeconomic factors to employment. Our results suggest that in addition to treatment, socioeconomic factors such as receipt of public disability benefits and educational attainment are associated with employment status. These results can help to inform future directions for the enhancement of psychosocial programs in FEP models to promote paid employment.
    Full-text · Article · Jun 2012
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