Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders.
Effort-based decision-making as a determinant of supported employment outcomes in psychotic disorders.
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基于努力的决策是精神障碍支持性就业结果的决定因素。
DOI：
10.1016/j.schres.2023.11.003
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发表时间：
2023
影响因子：
4.5
通讯作者：
Kern,RobertS
中科院分区：
文献类型：
--
作者：
Le,ThanhP;Green,MichaelF;Wynn,JonathanK;Iglesias,JulioE;Franco,RichardL;Kopelowicz,Alex;Kern,RobertS
精神分裂症与美国沉重的经济负担有关，部分原因是长期失业率高。个人安置和支持（IPS）是一种基于证据的支持就业类型，可以改善精神病患者的工作获得和工作成果。结果差异很大，IPS面临的一个持续挑战是在最初的求职阶段参与度低。过去的研究集中在面试为基础的动机赤字作为精神分裂症的治疗参与和工作成果差的一个关键决定因素。新的有效的绩效为基础的措施的动机，包括努力为基础的决策（EBDM）的任务，可以解释支持就业的结果，并提供见解IPS结果的个体差异。这项研究调查了IPS参与的程度（即，在服务提供的前四个月内参加的课程数量）与基线基于面试的动机缺陷和三项EBDM任务的表现有关-两项体力努力任务和一项认知努力任务（即，气球任务，奖励任务的努力支出，甲板选择努力任务）-在一个样本（N = 47）的人与精神障碍。结果表明，EBDM的表现水平，特别是在气球任务，预测IPS的参与，占额外的17%的方差以上，超越面试为基础的动机赤字（totalR 2 = 24%）。总的来说，这些研究结果表明，解决动机缺陷的努力为基础的决策可能是有益的IPS参与，这反过来可能会改善工作成果的轨迹。
Schizophrenia is associated with a heavy economic burden in the United States that is partly due to the high rates of chronic unemployment. Individual Placement and Support (IPS) is an evidenced-based type of supported employment that can improve job obtainment and work outcomes in psychotic disorders. Outcomes vary widely and a persistent challenge for IPS is low levels of engagement in the initial job search phase. Past studies have focused on interview-based motivation deficits as a key determinant of poor treatment engagement and work outcomes in schizophrenia. New validated performance-based measures of motivation, including effort-based decision-making (EBDM) tasks, may explain supported employment outcomes and provide insights into individual differences in IPS outcomes. This study investigated the degree to which IPS engagement (i.e., number of sessions attended during the first four months of service delivery) was related to baseline interview-based motivation deficits and performance on three EBDM tasks – two tasks of physical effort and one of cognitive effort (i.e., Balloon Task, Effort Expenditure for Rewards Task, Deck Choice Effort Task) – in a sample (N = 47) of people with a psychotic disorder. Results indicated that the level of EBDM performance, specifically on the Balloon Task, predicted IPS engagement, accounting for an additional 17 % of the variance above and beyond interview-based motivation deficits (totalR2= 24 %). Overall, these findings suggest that addressing motivational deficits in effort-based decision-making may be beneficial to IPS engagement, which in turn may improve the trajectory of work outcomes.