The Long-Term Impact of Employment on Mental Health Service Use and Costs for Persons With Severe Mental Illness
The Long-Term Impact of Employment on Mental Health Service Use and Costs for Persons With Severe Mental Illness
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DOI：
10.1176/appi.ps.60.8.1024
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发表时间：
2009-08-01
影响因子：
3.8
通讯作者：
Haslett, William R.
中科院分区：
文献类型：
--
作者：
Bush, Philip W.;Drake, Robert E.;Haslett, William R.
目的：稳定的就业通过提高收入和生活质量来促进严重精神疾病患者的康复，但其对心理健康成本的影响尚不清楚。这项研究调查了共生疾病研究参与者十年来的服务成本。方法：采用潜在班级增长分析确定竞争就业轨迹组。作者计算了187名参与者的年度门诊服务和住院费用，并检查了组内十年利用率和费用的差异。结果：稳定工作组(N=51)包括工作时间迅速增加，然后在10年内稳定在平均每人5,060小时的个人。晚工作组(N=57)和不工作组(N=79)在利用率或成本结果方面没有显著差异，因此将它们合并为最低工作组(N=136)。更多的教育，双相情感障碍的诊断(相对于精神分裂症或分裂情感障碍)，在过去一年的工作，以及扩展的简要精神病学评定量表上较低的分数预示着稳定工作组的成员。结果分析中对这些变量进行了控制。稳定工作组的门诊服务使用率明显高于最低工作组，而两组住院(医院、监狱或监狱)的住院率都下降了，没有显著差异。在十年的时间里，最低工作组的每位参与者的门诊服务和住院费用比稳定工作组的平均成本高出166,350美元。结论：服务使用量的显著减少与稳定的就业有关。鉴于就业支持对复苏的良好贡献，心理健康服务成本长期下降的证据应该会促使政策制定者和保险公司推动更广泛的实施。(精神科服务60：1024-1031,2009)
Objective: Stable employment promotes recovery for persons with severe mental illness by enhancing income and quality of life, but its impact on mental health costs has been unclear. This study examined service cost over ten years among participants in a co-occurring disorders study. Methods: Latent-class growth analysis of competitive employment identified trajectory groups. The authors calculated annual costs of outpatient services and institutional stays for 187 participants and examined group differences in ten-year utilization and cost. Results: A steady-work group (N=51) included individuals whose work hours increased rapidly and then stabilized to average 5,060 hours per person over ten years. A late-work group (N=57) and a no-work group (N=79) did not differ significantly in utilization or cost outcomes, so they were combined into a minimum-work group (N=136). More education, a bipolar disorder diagnosis (versus schizophrenia or schizoaffective disorder), work in the past year, and lower scores on the expanded Brief Psychiatric Rating Scale predicted membership in the steady-work group. These variables were controlled for in the outcomes analysis. Use of outpatient services for the steady-work group declined at a significantly greater rate than it did for the minimum-work group, while institutional (hospital, jail, or prison) stays declined for both groups without a significant difference. The average cost per participant for outpatient services and institutional stays for the minimum-work group exceeded that of the steady-work group by $166,350 over ten years. Conclusions: Highly significant reductions in service use were associated with steady employment. Given supported employment's well-established contributions to recovery, evidence of long-term reductions in the cost of mental health services should lead policy makers and insurers to promote wider implementation. (Psychiatric Services 60: 1024-1031, 2009)