Administration and Policy in Mental Health and Mental Health Services Research

, Volume 33, Issue 5, pp 598-606

First online:

Cognitive and Clinical Predictors of Work Outcomes in Clients with Schizophrenia Receiving Supported Employment Services: 4-year Follow-Up

  • Susan R. McGurkAffiliated withDepartment of Psychiatry, Dartmouth Medical SchoolNew Hampshire–Dartmouth Psychiatric Research Center Email author 
  • , Kim T. MueserAffiliated withDepartment of Psychiatry, Dartmouth Medical SchoolDepartment of Community and Family Medicine, Dartmouth Medical School

Rent the article at a discount

Rent 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.


Cognitive functioning Clinical symptoms Employment Schizophrenia Supported employement Mental health services