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，在教育不良、住房不足和社会支持方面的风险过高。尽管有促进康复的有效治疗方法，但许多重度精神分裂症患者除了在医院、监狱和监狱等昂贵的紧急护理场所外，无法获得服务。通过紧急护理代替其他预防性护理策略的治疗增加了复发、自杀和整体功能下降的风险就业活动可以通过提供结构和稳定性、加强社会支持、帮助人们摆脱贫困、提高动机和减轻症状来减少医院服务的使用。提出的论文将采用随机对照试验的数据，支持就业，药物管理和其他行为健康服务与常规护理。这些数据包括来自23个城市的2,238名参加社会保障残疾保险的患有精神分裂症或情绪障碍的工作年龄个人，他们接受增强或常规的精神保健和健康保险。本R36拨款提案旨在使用纵向多水平模型：(1)确定工作与医院护理使用之间关联的大小和因果方向；(2)检验工作与医院服务使用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，患有严重和持续性精神疾病的人在得到适当支持的情况下，能够而且确实参加了竞争激烈的工作因此，本研究将提供一个可行的策略，以减少昂贵和低效的医疗保健利用的有效性信息。

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.