THE RELATIONSHIP BETWEEN EMPLOYMENT STATUS AND NONVOCATIONAL OUTCOMES FOR PERSONS WITH SEVERE MENTAL ILLNESS ENROLLED IN VOCATIONAL PROGRAMS: A LONGITUDINAL STUDY

Abstract

The primary purpose of the current study was to determine the relationship between employment and the nonvocational functioning of people with severe mental illness in a prospective 24 month study, as a partial replication of another study. An employment typology was utilized that was comprised of participants at four employment levels: no work (those who did not work the entire study period), minimal work (those who worked 24 weeks or less in competitive and/or noncompetitive, paid employment), paid work (those who worked 24 or more weeks, the majority of which was spent in noncompetitive, paid employment), and competitive work (those who worked 24 or more weeks, the majority of which was spent in competitive employment). Both objective and subjective outcomes were addressed, including quality of life, symptoms, psychiatric hospitalizations, social networks, and residential status. Participants consisted of persons with severe mental illness (most with a schizophrenia-spectrum disorder) who were receiving employment services at a large, urban psychiatric rehabilitation center. Mixed effects regression modeling and logistic regression were used to analyze the date. Results indicate that the competitive work group experienced an accelerated improvement in negative symptoms across time and was less likely to have psychiatric hospitalization days as compared with the no work group. The paid work group showed an accelerated improvement in social network scores across time as compared with the no work, minimal work, and competitive work groups. The full sample demonstrated improvements across the study period regardless of employment typology status in the areas of overall quality of life, financial quality of life, cognitive symptoms, and social networks. In conclusion, this study adds to the growing body of evidence indicating that work, particularly periods of extended competitive work may lead to important benefits in clinical and social domains, although threats to internal validity that could not be ruled out preclude a causal link from being established. Future research is needed to further investigate this relationship, particularly in regards to those outcomes that are not well understood, such as residential status.