Lifetime employment in schizophrenia: correlates of developing long term unemployment after being employed before

ABSTRACT

Background

Challenges in employment are highly prevalent among people with schizophrenia regardless of their employment history. Although supportive employment can be effective, few participants sustain meaningful competitive employment. Our goal was to identify the correlates of developing sustained unemployment.

Methods

We examined employment outcomes by comparing clinical, neurocognitive, and social cognitive features in 234 participants with Schizophrenia Spectrum Disorders across t competitive employment outcomes: currently employed, participants who had never worked for a year, and those who had been employed but developed long-term unemployment. We examined social cognition and neurocognition, as well as positive and negative schizophrenia symptoms, and premorbid functioning and demographic factors.

Results

We found significant differences in age, race, premorbid functioning, cognitive performance, and social cognition between currently and formerly employed patients. When individual tasks were examined, emotion recognition and verbal working memory performance were the domains differentiating the groups. Older African Americans were over-represented in the formerly employed group.

Conclusions

There were minimal differences other than age and race between formerly employed patients and those who had never worked. These data suggest the possibility that deterioration in employment outcomes may also co-occur with declines in other abilities. Opportunities and disparities may also be a contributor to re-entering the work force.

KEYWORDS:

• Employment
• schizophrenia
• social cognition
• neurocognition
• premorbid functioning

Disclosure statement

Dr. Harvey has received consulting fees or travel reimbursements from Alkermes, Bioexcel, Boehringer Ingelheim, Intra-Cellular Therapies, Minerva Pharma, Regeneron Pharma, sand Sunovion Pharma during the past year. He receives royalties from the Brief Assessment of Cognition in Schizophrenia. He is chief scientific officer of i-Function, Inc. He has a research grant from Takeda and from the Stanley Medical Research Foundation. Dr. Pinkham has served as a consultant to Roche Pharma. Jarskog has received research grant funding from NIH, Auspex/Teva, Boehringer-Ingelheim and Otsuka. The other authors have no reportable biomedical activities.

Notes on contributors

Ms. Cynthia Fundora is research coordinators at the University of Miami, Miller School of Medicine.

Ms. Maria Cruz is research coordinators at the University of Miami, Miller School of Medicine.

Katelyn Barone is a research coordinator at the University of Miami Miller School of Medicine.

Dr. David L. Penn is professor at the University of North Carolina at Chapel Hill, in Psychiatry and Psychology respectively.

Dr. l. Frederik Jarskog is professor at the University of North Carolina at Chapel Hill, in Psychiatry and Psychology respectively.

Dr. Amy E. Pinkham is Associate professor of Psychiatry at the University of Texas at Dallas.

Dr. Philip D. Harvey is Leonard M. Miller Professor of Psychaitry at the University of Miami, Miller School of Medicine.

Additional information

Funding

This research was supported by NIMH grant RO1 MH 93432 to Drs. Harvey, Penn, and Pinkham.; National Institute of Mental Health (US).