The relationships between employment, clinical status, and psychiatric hospitalisation in patients with schizophrenia receiving either IPS or a conventional vocational rehabilitation programme

Reinhold Kilian*, Christoph Lauber, Rana Kalkan, Wulf Dorn, Wulf Roessler, Durk Wiersma, Jooske T. van Busschbach, Angelo Fioritti, Toma Tomov, Jocelyn Catty, Tom Burns, Thomas Becker, W. Rossler

*Corresponding author for this work

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Abstract

Positive relationships between employment and clinical status have been found in several studies. However, an unequivocal interpretation of these relationships is difficult on the basis of common statistical methods.

In this analysis, a structural equation model approach for longitudinal data was applied to identify the direction of statistical relationships between hours worked, clinical status and days in psychiatric hospital in 312 persons with schizophrenia who participated in a multi-centre randomised controlled trial comparing the effectiveness of Individual Placement and Support (IPS) with conventional vocational services in six study settings across Europe. Data were analysed by an autoregressive cross-lagged effects model, an autoregressive cross-lagged model with random intercepts and an autoregressive latent trajectory model.

Comparison of model fit parameters suggested the autoregressive cross-lagged effects model to be the best approach for the given data structure. All models indicated that patients who received an IPS intervention spent more hours in competitive employment and, due to indirect positive effects of employment on clinical status, spent fewer days in psychiatric hospitals than patients who received conventional vocational training.

Results support the hypothesis that the IPS intervention has positive effects not only on vocational but also on clinical outcomes in patients with schizophrenia.

Original languageEnglish
Pages (from-to)1381-1389
Number of pages9
JournalSocial Psychiatry and Psychiatric Epidemiology
Volume47
Issue number9
DOIs
Publication statusPublished - Sep-2012

Keywords

  • Supported employment
  • Psychosis
  • Vocational rehabilitation
  • Longitudinal analysis
  • ALT model
  • SEVERE MENTAL-ILLNESS
  • RANDOMIZED CONTROLLED-TRIAL
  • SUPPORTED EMPLOYMENT
  • PSYCHOTIC ILLNESS
  • RECOVERY
  • PEOPLE
  • MODELS
  • HEALTH
  • WORK
  • ALT

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