Abstract
Introduction
Employment is generally beneficial to health and quality of life. Despite many advances in the treatment of psychosis there are continuing reports of high levels of unemployment. In most studies of first episode psychosis (FEP) only rudimentary rates of employment are provided. We sought to establish the prevalence of employment amongst those with FEP from a geographically defined area, to compare employment categories for differences in demographical and clinical characteristics and finally, to examine factors associated with employment.
Methods
All cases of FEP were assessed from a defined suburban area with a structured clinical interview for DSM-III-R diagnosis and a standardised assessment protocol. Employment status was divided into employed, non-labour force work and unemployed.
Results
Of 162 cases of psychosis, those employed (46%) were indistinguishable from those in non-labour force work (21%). Those unemployed (33%) had significantly longer DUP, more negative symptoms and lower quality of life than those engaged in non-labour force work or those employed. Having a non-affective psychosis (χ2 = 0.05, OR = 1.2; 95% CI 1.0, 1.4) was associated with being unemployed at presentation. Better (β = −0.2, P = 0.00) academic premorbid adjustment was associated with being employed at presentation.
Conclusions
Although 67% of those with FEP from a geographically defined area are engaged in purposeful work, the rate of unemployment is nine times the local rate. Longer DUP and negative symptoms are associated with unemployment at presentation. Standardised reporting of employment status would greatly assist research in this area.
Similar content being viewed by others
References
Beiser M, Erickson D, Fleming JA, Iacono WG (1993) Establishing the onset of psychotic illness. Am J Psychiatry 150(9):1349–1354
Bond GR, Drake RE, Mueser KT, Becker DR (1997) An update on supported employment for people with severe mental illness. Psychiatr Serv 48(3):335–346
Browne S, Clarke M, Gervin M, Waddington JL, Larkin C, O’Callaghan E (2000) Determinants of quality of life at first presentation with schizophrenia. Br J Psychiatry 176:173–176
Burns T, Catty J, Becker T, Drake RE, Fioritti A, Knapp M, Lauber C, Rössler W, Tomov T, van Busschbach J, White S, Wiersma D, EQOLISE Group (2007) The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 370(9593):1146–1152
Byrne M, Agerbo E, Mortensen PB (2002) Family history of psychiatric disorders and age at first contact in schizophrenia: an epidemiological study. Br J Psychiatry 43:19–25
Cannon M, Jones P, Gilvarry C, Rifkin L, McKenzie K, Foerster A, Murray RM (1997) Premorbid social functioning in schizophrenia and bipolar disorder: similarities and differences. Am J Psychiatry 154(11):1544–1550
Cannon-Spoor HE, Potkin SG, Wyatt RJ (1982) Measurement of premorbid adjustment in chronic schizophrenia. Schizophr Bull 8(3):470–484
Dobson DJ, McDougall G, Busheikin J, Aldous J (1995) Effects of social skills training and social milieu treatment on symptoms of schizophrenia. Psychiatr Serv 46(4):376–380
Foerster A, Lewis S, Owen M, Murray R (1991) Pre-morbid adjustment and personality in psychosis: effects of sex and diagnosis. Br J Psychiatry 158:171–176
Heinrichs DW, Hanlon TE, Carpenter WT Jr (1984) The quality of life scale: an instrument for rating the schizophrenic deficit syndrome. Schizophr Bull 10(3):388–398
Kay S, Fiszbein A, Opler L (1987) The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 13:261–276
Marshall M (2005). How effective are different types of day care services for people with severe mental disorders? Copenhagen, WHO Regional Office for Europe. Health Evidence Network report. http://www.euro.who.int/Document/E87317.pdf. Accessed 26 March 2008
Marwaha S, Balachandra S, Johnson S (2008) Clinicians’ attitudes to the employment of people with psychosis. Soc Psychiatry Psychiatr Epidemiol [Epub ahead of print]
Marwaha S, Johnson S (2004) Schizophrenia and employment—a review. Soc Psychiatry Psychiatr Epidemiol 39(5):337–349
Michon HW, van Weeghel J, Kroon H, Schene AH (2005) Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes—a systematic review. Soc Psychiatry Psychiatr Epidemiol 40(5):408–416
Norman RM, Mallal AK, Manchanda R, Windell D, Harricharan R, Takhar J, Northcott S (2007) Does treatment delay predict occupational functioning in first-episode psychosis? Schizophr Res 91(1–3):259–262
Perkins DO, Gu H, Boteva K, Lieberman JA (2005) Relationship between duration of untreated psychosis and outcome in first-episode schizophrenia: a critical review and meta-analysis. Am J Psychiatry 162(10):1785–1804
Perkins R, Rinaldi M (2002) Unemployment rates among patients with long term mental health problems. Psychiatr Bull 26:295–298
Rankin J (2005) Mental health and social inclusion. Institute for Public Policy Research, London
Reininghaus UA, Morgan C, Simpson J, Dazzan P, Morgan K, Doody GA, Bhugra D, Leff J, Jones P, Murray R, Fearon P, Craig TK (2008) Unemployment, social isolation, achievement-expectation mismatch and psychosis: findings from the AESOP study. Soc Psychiatry Psychiatr Epidemiol 43(9):743–751
Rinaldi M, McNeil K, Firn M, Koletsi M, Perkins R, Singh SP (2004) What are the benefits of evidence-based supported employment for patients with first-episode psychosis? Psychiatr Bull 28:281–284
Rosenheck R, Leslie D, Keefe R, McEvoy J, Swartz M, Perkins D, Stroup S, Hsiao JK, Lieberman J, CATIE Study Investigators Group (2006) Barriers to employment for people with schizophrenia. Am J Psychiatry 163(3):411–417
Shortt SE (1996) Is unemployment pathogenic? A review of current concepts with lessons for policy planners. Int J Health Serv 26(3):569–589
Singh SP, Burns T, Amin S, Jones PB, Harrison G (2008) Acute and transient psychotic disorders: precursors, epidemiology, course and outcome. Br J Psychiatry 185:452–459
Singh SP, Croudace T, Amin S, Kwiecinski R, Medley I, Jones PB, Harrison G (2000) Three-year outcome of first-episode psychoses in an established community psychiatric service. Br J Psychiatry 176:210–216
Spitzer RL, Williams JB, Gibbon M, First MB (1992) The structured clinical interview for DSM-III-R (SCID) I: history, rationale, and description. Arch Gen Psychiatry 49(8):624–629
Stoneman P, Anderson B (2006) ‘Social capital, quality of life, employment and ICTs’, Chimera working paper 2006–2004. University of Essex, Ipswich
The Sainsbury Centre for Mental Health (2004) Counting the cost: the economic and social costs of mental illness in Northern Ireland. The Sainsbury Centre for Mental Health, London
Waddell G, Burton AK (2006) Is work good for your health and well being?. TSO (The Stationary Office), Norwich
United Nations (1980) Principles and recommendations for population and housing censuses, Series M, No. 67, New York
Acknowledgments
We thank the study participants and their families. This study was supported by the Stanley Medical Research Institute, the Health Research Board of Ireland and the Science Foundation Ireland.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Turner, N., Browne, S., Clarke, M. et al. Employment status amongst those with psychosis at first presentation. Soc Psychiat Epidemiol 44, 863–869 (2009). https://doi.org/10.1007/s00127-009-0008-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-009-0008-6