Work and hospital utilization among disability beneficiaries with mental illness

描述（由申请人提供）：患有严重和持续性精神疾病（SMI）的人，如精神分裂症，双相情感障碍或重度抑郁症，受教育程度低，住房不足和社会支持的风险较高。尽管有促进康复的有效治疗方法，但许多患有SMI的人除了在昂贵的紧急护理环境中外，医院、监狱和监狱。1 -4通过紧急护理代替其他预防性护理策略进行治疗会增加复发、自杀和整体功能较差的风险。5就业活动可以通过提供结构和稳定性、增强社会支持、帮助人们摆脱贫困、提高动力和减少焦虑来减少医院服务的使用。6，[7]这篇论文将采用一项随机对照试验的数据，该试验是关于支持性就业、药物管理和其他行为健康服务与常规护理的比较。这些数据包含来自23个城市的2，238名参加社会保障残疾保险的工作年龄精神分裂症或情绪障碍患者，他们接受了增强或常规的精神保健和健康保险。这项R36拨款提案旨在使用纵向多层次模型：（1）确定工作和医院护理使用之间关联的大小和因果方向;（2）测试工作和医院服务使用之间的关系是否对工作强度，工作稳定性或工作适合度敏感。大量证据一致表明，严重和持续性精神疾病患者可以并且确实在提供适当支持的情况下参与竞争性劳动力。8因此，本研究将提供有关可行策略有效性的信息，以减少昂贵和低效的医疗保健利用。

DESCRIPTION (provided by applicant): People with severe and persistent mental illness (SMI) such as schizophrenia, bipolar disorder, or major depressive disorder are at disproportionally high risk for poor education, inadequate housing, and social supports. Despite the availability of effective treatments that promote recovery, many people with SMI do not access services except in costly urgent care settings, e.g., hospitals, jails, and prisons.1-4 Treatment via urgent care in lieu of other preventive care strategies increases the risk of relapse, suicidality, and poorer overall functioning.5 Employment activity may decrease hospital service use by providing structure and stability, enhancing social support, helping people escape from poverty, improving motivation, and decreasing symptoms.6, 7 The proposed dissertation will employ data from a randomized controlled trial of supported employment, medication management, and other behavioral health services versus usual care. These data contain 2,238 working age individuals with schizophrenia or mood disorder enrolled in Social Security Disability Insurance from 23 cities, receiving enhanced or usual mental healthcare and health insurance. This R36 grant proposal aims to use longitudinal multilevel modeling: (1) to determine the size and causal direction of associations between work and hospital care use; and (2) to test whether the relationship between work and hospital service use is sensitive to job intensity, job stability, or job fit.!A large body of evidence consistently demonstrates that peopl with severe and persistent mental illness can and do participate in the competitive workforce when provided appropriate supports.8 Thus, this study will provide information on the effectiveness of a feasible strategy to reduce costly and inefficient healthcare utilization.