Barriers to employment for people with schizophrenia
Barriers to employment for people with schizophrenia
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DOI：
10.1176/appi.ajp.163.3.411
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发表时间：
2006-03-01
影响因子：
17.7
通讯作者：
Lieberman, J
中科院分区：
文献类型：
--
作者：
Rosenheck, R;Leslie, D;Lieberman, J
目的：越来越多的人对识别和克服精神分裂症患者的就业障碍感兴趣。作者在参加临床抗精神病药物干预有效性试验（CATIE）研究的一大群精神分裂症患者中，研究了与参与竞争性就业或其他职业活动相关的因素，CATIE是一项比较第一代和第二代抗精神病药物效果的多中心临床试验。在进入CATIE研究之前，收集了1,400多名诊断为精神分裂症的患者的基线数据。多项logistic回归分析被用来研究参与竞争性就业或其他职业活动与社会人口学特征、精神分裂症症状、神经认知功能、心理功能、心理社会康复服务的可用性和当地失业率之间的关系。总的来说，14.5%的患者报告在基线评估前一个月参加了竞争性就业，12.6%的患者报告了其他（非竞争性）就业活动，72.9%的人报告没有就业活动。参与竞争性或非竞争性就业与症状较轻，神经认知功能较好，以及在包括动机，同理心和其他心理特征在内的心理功能测量中得分较高有关。与其他就业或没有就业相比，有竞争力的就业与领取残疾津贴以及作为黑人呈负相关。更多地获得康复服务与更多地参与竞争性和非竞争性employment.Conclusions：精神分裂症患者的整体就业似乎受到临床问题的阻碍，包括精神分裂症的症状和较差的神经认知和精神内功能。然而，残疾津贴的潜在不利激励和种族因素可能会具体阻碍参与竞争性就业，而康复服务的提供可能会促进这种参与。
Objective: There is growing interest in identifying and surmounting barriers to employment for people with schizophrenia. The authors examined factors associated with participation in competitive employment or other vocational activities in a large group of patients with schizophrenia who participated in the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study, a multisite clinical trial comparing the effects of first- and second-generation antipsychotics.Method: Baseline data on more than 1,400 patients with a diagnosis of schizophrenia were collected before their entry into the CATIE study. Multinomial logistic regression was used to examine the relationship between participation in either competitive employment or other vocational activities and sociodemographic characteristics, schizophrenia symptoms, neurocognitive functioning, intrapsychic functioning, availability of psychosocial rehabilitation services, and local unemployment rates.Results: Altogether, 14.5% of the patients reported participating in competitive employment in the month before the baseline assessment, 12.6% reported other (noncompetitive) employment activity, and 72.9% reported no employment activity. Participation in either competitive or noncompetitive employment was associated with having less severe symptoms, better neurocognitive functioning, and higher scores on a measure of intrapsychic functioning that encompassed motivation, empathy, and other psychological characteristics. Competitive employment, in contrast to other employment or no employment, was negatively associated with receipt of disability payments as well as with being black. Greater access to rehabilitation services was associated with greater participation in both competitive and noncompetitive employment.Conclusions: Overall employment of persons with schizophrenia seems to be impeded by clinical problems, including symptoms of schizophrenia and poorer neurocognitive and intrapsychic functioning. However, participation in competitive employment may be specifically impeded by the potentially adverse incentives of disability payments and by race and may be promoted by the availability of rehabilitation services.