Cognitive and Clinical Predictors of Work Outcomes in Clients with Schizophrenia Receiving Supported Employment Services: 4-year Follow-Up
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
In a prior study we showed that cognitive functioning was a modest predictor of work and supported employment services over 2-years in 30 clients with schizophrenia, whereas symptoms were not (McGurk et al. (2003). Psychiatric Services, 58, 1129–1135). In order to evaluate whether the long-term provision of supported employment services reduced the impact of cognitive functioning on work, we examined the relationships between cognitive functioning and symptoms assessed after the initial 2 years of the program, and work and vocational services over the following 2 years (3–4 years after joining the program). Cognitive functioning was more predictive of work during the latter 2 years of the study than the first 2 years, and a similar but weaker pattern was present for the prediction of employment services. Symptoms remained weak predictors for both time periods. In addition, learning and memory and executive functions were strongly correlated with job task complexity during the 3–4 year follow-up, but not the 1–2 year follow-up, suggesting that employment specialists were able to improve their ability to match clients to jobs based on their cognitive skills. Furthermore, the specific associations between cognitive functioning, services, and work outcomes changed from years 1–2 to years 3–4, suggesting a dynamic interplay between these factors over the long-term, rather than static and unchanging relationships. The findings indicate that rather than supported employment services reducing the impact of cognitive functioning on long-term competitive work, the impact actually increases over time, suggesting that efforts to improve cognitive functioning (e.g., cognitive rehabilitation) may optimize employment outcomes in schizophrenia.
- Andreasen, N. C., Flaum, M., & Arndt, S. (1992). The Comprehensive Assessment of Symptoms and History (CASH). An instrument for assessing diagnosis and psychopathology. Archives of General Psychiatry, 49, 615–623.
- Anthony, W. A., & Jansen, M. A. (1984). Predicting the vocational capacity of the chronically mentally ill. American Psychologist, 39, 537–544. CrossRef
- Becker, D. R., & Drake, R. E. (2003). A working life for people with severe mental illness. New York: Oxford University Press.
- Berg, E. A. (1948). A simple objective test for measuring flexibility in thinking. Journal of General Psychology, 39, 15–22. CrossRef
- Bond, G. R., Drake, R. E., Mueser, K. T., & Becker, D. R. (1997). An update on supported employment for people with severe mental illness. Psychiatric Services, 48, 335–346.
- Cook, J. A., & Razzano, L. (2000). Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophrenia Bulletin, 26, 87–103.
- Delis, D. C., Kramer, J. H., Kaplan, E., & Ober, B. A. (1987). California verbal learning and memory test (Manual). San Antonio, TX: Psychological Corporation.
- Dickerson, F. B., Boronow, J. J., Stallings, C. R., Origoni, A. E., & Yolken, R. H. (2004). Association between cognitive functioning and employment status of person with bipolar disorder. Psychiatric Services, 55, 54–58. CrossRef
- Gold, J. M. (2004). Cognitive deficits as treatment targets in schizophrenia. Schizophrenia Research, 72, 21–28. CrossRef
- Gold J. M., Goldberg, R. W., McNary, S. W., Dixon, L. B., & Lehman, A. F. (2002). Cognitive correlates of job tenure among patients with severe mental illness. American Journal of Psychiatry, 159, 1395–1402. CrossRef
- Harvey, P. D., Moriarty, P. J., Friedman, J. I., White, L., Parrella, M., Mohs, R. C., & Davis, K. L. (2000). Differential preservation of cognitive functions in geriatric patients with lifelong chronic schizophrenia: Less impairment in reading compared to other skill areas. Biological Psychiatry, 47, 962–968. CrossRef
- Kay, S. R., Fiszbein, A., & Opler, L.A. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–276.
- Lehman, A. F., Goldberg, R., Dixon, L. B., McNary, S., Postrado, L., Hackman, A., et al. (2002). Improving employment outcomes for persons with severe mental illnesses. Archives of General Psychiatry, 59, 165–172. CrossRef
- McGurk, S. R., & Mueser, K. T. (2003). Cognitive functioning and employment in severe mental illness. Journal of Nervous and Mental Disease, 191, 789–798. CrossRef
- McGurk, S. R., & Mueser, K. T. (2004). Cognitive functioning, symptoms, and work in supported employment: A review and heuristic model. Schizophrenia Research, 70, 147–174. CrossRef
- McGurk, S. R., Mueser, K.T., Harvey, P. D., LaPuglia, R., & Marder, J. (2003). Cognitive and clinical predictors of work outcomes in clients with schizophrenia receiving supported employment services. Psychiatric Services, 58, 1129–1135. CrossRef
- Mueser, K. T. (2002). Cognitive impairment, symptoms, social functioning, and vocational rehabilitation in schizophrenia. In H. Kashima, I. R. H. Falloon, M. Mizuno, & M. Asai (Eds.), Comprehensive treatment of schizophrenia: Linking neurobehavioral findings to psychosocial approaches (pp. 344–351). Tokyo: Springer-Verlag.
- Mueser, K. T. Clark, R. E. Haines, M., Drake, R. E., McHugo, G. J., Bond, G. R., Essock, S. M., Becker, D. R., Wolfe, R., & Swain, R. (2004). The Hartford study of supported employment for severe mental illness: Employment and non-vocational outcomes. Journal of Consulting and Clinical Psychology, 72, 479–490. CrossRef
- Radford, L. M., Chaney, E. F., & O'Leary, M. R. (1978). Screening for cognitive impairment among inpatients. Journal of Clinical Psychiatry, 39, 712.
- Wechsler, D. (1981). Wechsler adult intelligence scale-revised. New York: Harcourt, Brace, Jovanovich.
- Wechsler, D. (1998). Wechsler adult intelligence scale III manual. New York, NY: Psychological Corp.
- Weissman, M. M., & Paykel, E. S. (1974). The depressed woman: A study of social relationships. Chicago: University of Chicago Press.
- White L, Harvey P. D., Opler L., Lindenmayer J. P., & the PANSS Study Group. (1997). Empirical assessment of the factorial structure of clinical symptoms in schizophrenia: a multisite, multimodel evaluation of the factorial structure of the positive and negative syndrome scale. Psychopathology, 30, 263–274.
- Wilkinson, G. (1993). Wide range achievement test 3, manual. Wilmington, Delaware: Wide Range, Inc.
- Cognitive and Clinical Predictors of Work Outcomes in Clients with Schizophrenia Receiving Supported Employment Services: 4-year Follow-Up
Administration and Policy in Mental Health and Mental Health Services Research
Volume 33, Issue 5 , pp 598-606
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Cognitive functioning
- Clinical symptoms
- Supported employement
- Mental health services
- Author Affiliations
- 1. Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA
- 3. New Hampshire–Dartmouth Psychiatric Research Center, Main Building, 105 Pleasant St, Concord, NH, 03301, USA
- 2. Department of Community and Family Medicine, Dartmouth Medical School, Hanover, NH, USA