Skip to main content
SpringerLink
Log in

Occupational functioning, symptoms and neurocognition in patients with psychotic disorders: investigating subgroups based on social security status

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Reported employment rates for patients with psychosis are low, but vary partly depending on illness phase. Illness-related factors such as neurocognition and negative symptoms are associated with occupational functioning, while external factors may also act as barriers for employment. The current study investigated the relationship between neurocognition, symptoms and employment using a threefold division of employment status: employed, receiving temporary benefits and receiving disability benefits. The latter group was divided into two based on level of social functioning.

Methods

A total of 155 patients with broad DSM-IV schizophrenia spectrum disorder were assessed with clinical, neurocognitive and social and occupational functioning measures. Group differences were analyzed with ANOVAs and hierarchical regression analysis.

Results

Thirteen percent were employed, 52 % received temporary benefits and 35 % received disability benefits. There were no differences in symptom level and neurocognitive functioning between groups. Among patients on disability benefits, the subgroup with higher social functioning had fewer negative and general symptoms and a trend for better neurocognition compared with those with lower social functioning, thus being more similar to employed patients. Negative symptoms and executive functioning explained 26 % of the variance in social functioning for patients receiving disability benefits.

Conclusions

The association between neurocognition and employment may not be as strong as previously assumed, due to external factors that may influence this relationship. Patients on disability benefits rated high on social functioning showed similarities with employed patients. This could imply that these patients have some work capacity. This issue needs further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Schennach R, Musil R, Moller HJ, Riedel M (2012) Functional outcomes in schizophrenia: employment status as a metric of treatment outcome. Curr Psychiatry Rep 14:229–236

    Article  PubMed  Google Scholar 

  2. Marwaha S, Johnson S (2004) Schizophrenia and employment—a review. Soc Psychiat Psychiatry Epidemiol 39:337–349

    Article  Google Scholar 

  3. Rinaldi M, Killackey E, Smith J, Shepherd G, Singh SP, Craig T (2010) First episode psychosis and employment: a review. Intern Rev Psychiatry 22:148–162

    Article  Google Scholar 

  4. Tsang HW, Leung AY, Chung RC, Bell M, Cheung WM (2010) Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998. Aust N Z J Psychiar 44:495–504

    Google Scholar 

  5. Bell MD, Bryson G (2001) Work rehabilitation in schizophrenia: does cognitive impairment limit improvement? Schizophr Bull 27:269–279

    Article  PubMed  CAS  Google Scholar 

  6. Bryson G, Bell MD (2003) Initial and final work performance in schizophrenia: cognitive and symptom predictors. J Nerv Ment Dis 191:87–92

    PubMed  Google Scholar 

  7. Christensen TØ (2007) The influence of neurocognitive dysfunctions on work capacity in schizophrenia patients: a systematic review of the literature. Inter J Psychiatry Clin Pract 11:89–101

    Article  Google Scholar 

  8. Green MF, Kern RS, Heaton RK (2004) Longitudinal studies of cognition and functional outcome in schizophrenia: implications for MATRICS. Schizophr Res 72:41–51

    Article  PubMed  Google Scholar 

  9. Hofer A, Baumgartner S, Bodner T et al (2005) Patient outcomes in schizophrenia II: the impact of cognition. Eur Psychiatry 20:395–402

    Article  PubMed  Google Scholar 

  10. McGurk SR, Mueser KT (2004) Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model. Schizophr Res 70:147–173

    Article  PubMed  Google Scholar 

  11. August SM, Kiwanuka JN, McMahon RP, Gold JM (2012) The MATRICS consensus cognitive battery (MCCB): clinical and cognitive correlates. Schizophr Res 134:76–82

    Article  PubMed  Google Scholar 

  12. Hofer A, Bodner T, Kaufmann A et al (2011) Symptomatic remission and neurocognitive functioning in patients with schizophrenia. Psychol Med 41:2131–2139

    Article  PubMed  CAS  Google Scholar 

  13. Dickerson FB, Stallings C, Origoni A, Boronow JJ, Sullens A, Yolken R (2008) Predictors of occupational status six months after hospitalization in persons with a recent onset of psychosis. Psychiatry Res 160:278–284

    Article  PubMed  Google Scholar 

  14. Tan BL (2009) Profile of cognitive problems in schizophrenia and implications for vocational functioning. Aust Occup Ther J 56:220–228

    Article  PubMed  Google Scholar 

  15. Erickson M, Jaafari N, Lysaker P (2011) Insight and negative symptoms as predictors of functioning in a work setting in patients with schizophrenia. Psychiatry Res 189:161–165

    Article  PubMed  Google Scholar 

  16. Heinrichs RW, Ammari N, Miles A, McDermid VS, Chopov B (2009) Psychopathology and cognition in divergent functional outcomes in schizophrenia. Schizophr Res 109:46–51

    Article  PubMed  Google Scholar 

  17. Shamsi S, Lau A, Lencz T et al (2011) Cognitive and symptomatic predictors of functional disability in schizophrenia. Schizophr Res 126:257–264

    Article  PubMed  Google Scholar 

  18. Ventura J, Hellemann GS, Thames AD, Koellner V, Nuechterlein KH (2009) Symptoms as mediators of the relationship between neurocognition and functional outcome in schizophrenia: a meta-analysis. Schizophr Res 113:189–199

    Article  PubMed  Google Scholar 

  19. Allott K, Liu P, Proffitt TM, Killackey E (2011) Cognition at illness onset as a predictor of later functional outcome in early psychosis: systematic review and methodological critique. Schizophr Res 125:221–235

    Article  PubMed  Google Scholar 

  20. Tandberg M, Ueland T, Andreassen OA, Sundet K, Melle I (2012) Factors associated with occupational and academic status in patients with first-episode psychosis with a particular focus on neurocognition. Soc Psychiatry Psychiatr Epidemiol. doi:10.1007/s00127-012-0477

    Google Scholar 

  21. Burns T, Catty J, Becker T et al (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 370:1146–1152

    Article  PubMed  Google Scholar 

  22. Tandberg M, Ueland T, Sundet K et al (2011) Neurocognition and occupational functioning in patients with first-episode psychosis: a 2-year follow-up study. Psychiatry Res 188:334–342

    Article  PubMed  Google Scholar 

  23. Dickerson FB, Stallings C, Origoni A, Boronow JJ, Sullens A, Yolken R (2007) The association between cognitive functioning and occupational status in persons with a recent onset of psychosis. J Nerv Ment Dis 195:566–571

    Article  PubMed  Google Scholar 

  24. Gold JM, Queern C, Iannone VN, Buchanan RW (1999) Repeatable battery for the assessment of neuropsychological status as a screening test in schizophrenia I: sensitivity, reliability, and validity. Am J Psychiatry 156:1944–1950

    PubMed  CAS  Google Scholar 

  25. Palmer BW, Heaton RK, Gladsjo JA, Evans JD, Patterson TL, Golshan S, Jeste DV (2002) Heterogeneity in functional status among older outpatients with schizophrenia: employment history, living situation, and driving. Schizophr Res 55:205–215

    Article  PubMed  Google Scholar 

  26. Helle S, Gråwe RW (2007) Sysselsetting og trygd blant personer med schizofrenidiagnose. Tidsskrift for Norsk Psykologforening 44:1358–1362

    Google Scholar 

  27. Kiviniemi M, Suvisaari J, Pirkola S, Laksy K, Hakkinen U, Isohanni M, Hakko H (2011) Five-year follow-up study of disability pension rates in first-onset schizophrenia with special focus on regional differences and mortality. Gen Hosp Psychiatry 33:509–517

    Article  PubMed  Google Scholar 

  28. Birchwood M, Smith J, Cochrane R, Wetton S, Copestake S (1990) The social functioning scale. The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry 157:853–859

    Article  PubMed  CAS  Google Scholar 

  29. Mueser KT, Salyers MP, Mueser PR (2001) A prospective analysis of work in schizophrenia. Schizophr Bull 27:281–296

    Article  PubMed  CAS  Google Scholar 

  30. Wechsler D (2007) Wechsler abbreviated scale of intelligence (WASI). Norwegian manual supplement. Pearson Assessment, Stockholm

    Google Scholar 

  31. Sundet K, Vaskinn A (2008) Estimating premorbid IQ (in Norwegian with English abstract). J Nor Psychol Assoc 45:1108–1115

    Google Scholar 

  32. Delis DC, Kramer JH, Kaplan E, Ober BA (2004) California verbal learning test (CVLT-II). Norwegian manual supplement. Pearson Assessment, Stockholm

    Google Scholar 

  33. First MB, Spitzer RL, Gibbon M, Williams JBW (1995) Structural clinical interview for DSM-IV axis I disorders-patient edition (SCID I/P, version 2.0). New York State Psychiatric Institute, Biometrics Research Department, New York

    Google Scholar 

  34. Kay SR, Fiszbein A, Opler LA (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276

    Article  PubMed  CAS  Google Scholar 

  35. American Psychiatric Association (1995) Diagnostic and statistical manual of mental disorders. American Psychiatric Association, Washington DC

    Google Scholar 

  36. Pedersen G, Hagtvet KA, Karterud S (2007) Generalizability studies of the global assessment of functioning-split version. Compr Psychiatry 48:88–94

    Article  PubMed  Google Scholar 

  37. Hellvin T, Sundet K, Vaskinn A, Simonsen C, Ueland T, Andreassen OA, Melle I (2010) Validation of the Norwegian version of the social functioning scale (SFS) for schizophrenia and bipolar disorder. Scand J Psychol 51:525–533

    Article  PubMed  Google Scholar 

  38. Wechsler D (2003) Wechsler adult intelligence scale—third edition (WAIS-III). Norwegian manual. Pearson Assessment, Stockholm

    Google Scholar 

  39. Delis DC, Kaplan E, Kramer JH (2005) The Delis-Kaplan executive function system (D-KEFS). Norwegian manual. Pearson Assessment, Stockholm

    Google Scholar 

  40. Haatveit BC, Sundet K, Hugdahl K, Ueland T, Melle I, Andreassen OA (2010) The validity of d prime as a working memory index: results from the “Bergen n-back task”. J Clin Exp Neuropsychol 32:871–880

    Article  PubMed  Google Scholar 

  41. Matthews CG, Kløve H (1964) Instruction manual for the adult neuropsychology test battery. University of Wisconsin Medical School, Madison

    Google Scholar 

  42. Middelboe T, Mackeprang T, Hansson L et al (2001) The Nordic Study on schizophrenic patients living in the community. Subjective needs and perceived help. Eur Psychiatry 16:207–214

    Article  PubMed  CAS  Google Scholar 

  43. Leeson VC, Barnes TR, Hutton SB, Ron MA, Joyce EM (2009) IQ as a predictor of functional outcome in schizophrenia: a longitudinal, four-year study of first-episode psychosis. Schizophr Res 107:55–60

    Article  PubMed  Google Scholar 

  44. Khandaker GM, Barnett JH, White IR, Jones PB (2011) A quantitative meta-analysis of population-based studies of premorbid intelligence and schizophrenia. Schizophr Res 132:220–227

    Article  PubMed  Google Scholar 

  45. Milev P, Ho BC, Arndt S, Andreasen NC (2005) Predictive values of neurocognition and negative symptoms on functional outcome in schizophrenia: a longitudinal first-episode study with 7-year follow-up. Am J Psychiatry 162:495–506

    Article  PubMed  Google Scholar 

  46. Verdoux H, Liraud F, Assens F, Abalan F, van Os J (2002) Social and clinical consequences of cognitive deficits in early psychosis: a two-year follow-up study of first-admitted patients. Schizophr Res 56:149–159

    Article  PubMed  Google Scholar 

  47. Breitborde NJ, Srihari VH, Woods SW (2009) Review of the operational definition for first-episode psychosis. Early Interv Psychiatry 3:259–265

    Article  PubMed  Google Scholar 

  48. Bond GR, Drake RE (2008) Predictors of competitive employment among patients with schizophrenia. Curr Opin Psychiatry 21:362–369

    Article  PubMed  Google Scholar 

  49. Bowie CR, Reichenberg A, Patterson TL, Heaton RK, Harvey PD (2006) Determinants of real-world functional performance in schizophrenia subjects: correlations with cognition, functional capacity, and symptoms. Am J Psychiatry 163:418–425

    Article  PubMed  Google Scholar 

  50. Xiang YT, Shum D, Chiu HF, Tang WK, Ungvari GS (2010) Association of demographic characteristics, symptomatology, retrospective and prospective memory, executive functioning and intelligence with social functioning in schizophrenia. Aust N Z J Psychiatry 44:1112–1117

    Article  PubMed  Google Scholar 

  51. Meesters PD, Stek ML, Comijs HC, De HL, Patterson TL, Eikelenboom P, Beekman AT (2010) Social functioning among older community-dwelling patients with schizophrenia: a review. Am J Geriatr Psychiatry 18:862–878

    Article  PubMed  Google Scholar 

  52. Oie M, Sundet K, Ueland T (2011) Neurocognition and functional outcome in early-onset schizophrenia and attention-deficit/hyperactivity disorder: a 13-year follow-up. Neuropsychology 25:25–35

    Article  PubMed  Google Scholar 

  53. Bowie CR, Leung WW, Reichenberg A, McClure MM, Patterson TL, Heaton RK, Harvey PD (2008) Predicting schizophrenia patients’ real-world behavior with specific neuropsychological and functional capacity measures. Biol Psychiatry 63:505–511

    Article  PubMed  Google Scholar 

  54. Midin M, Razali R, Zamzam R et al (2011) Clinical and cognitive correlates of employment among patients with schizophrenia: a cross-sectional study in Malaysia. Int J Ment Health Syst 5:14

    Article  PubMed  Google Scholar 

  55. Velligan DI, Bow-Thomas CC, Mahurin RK, Miller AL, Halgunseth LC (2000) Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? J Nerv Ment Dis 188:518–524

    Article  PubMed  CAS  Google Scholar 

  56. Kurtz MM, Wexler BE, Bell MD (2004) The Penn conditional exclusion test (PCET): relationship to the Wisconsin card sorting test and work function in patients with schizophrenia. Schizophr Res 68:95–102

    Article  PubMed  Google Scholar 

  57. Drake RJ, Dunn G, Tarrier N, Bentall RP, Haddock G, Lewis SW (2007) Insight as a predictor of the outcome of first-episode nonaffective psychosis in a prospective cohort study in England. J Clin Psychiatry 68:81–86

    Article  PubMed  Google Scholar 

  58. Simonsen C, Sundet K, Vaskinn A et al (2010) Psychosocial function in schizophrenia and bipolar disorder: relationship to neurocognition and clinical symptoms. J Int Neuropsychol Soc 16:771–783

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Mental Health and Addiction, Psychosis Research Unit, Ullevål Hospital, Oslo University Hospital, P.O. Box 4956, Nydalen, 0424, Oslo, Norway

    Marte Tandberg, Kjetil Sundet, Ole A. Andreassen, Ingrid Melle & Torill Ueland

  2. Department of Psychology, University of Oslo, P.O. Box 1094, Blindern, 0317, Oslo, Norway

    Marte Tandberg & Kjetil Sundet

  3. Section of Psychiatry, Insitute of Clinical Medicine, University of Oslo, Oslo, Norway

    Ole A. Andreassen & Ingrid Melle

Authors
  1. Marte Tandberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kjetil Sundet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ole A. Andreassen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ingrid Melle
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Torill Ueland
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marte Tandberg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Tandberg, M., Sundet, K., Andreassen, O.A. et al. Occupational functioning, symptoms and neurocognition in patients with psychotic disorders: investigating subgroups based on social security status. Soc Psychiatry Psychiatr Epidemiol 48, 863–874 (2013). https://doi.org/10.1007/s00127-012-0598-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-012-0598-2

Keywords

Search

Navigation