Abstract
Purpose
This study investigated the relationships among insight, psychopathology, cognitive function, and competitive employment in order to determine whether insight and/or psychopathology carried the influence of cognitive function to competitive employment.
Methods
We recruited 253 outpatients with stable schizophrenia and we further divided our sample into two groups of patients (unemployed and competitive employment subjects). Clinical and neuropsychological assessments were performed. All clinical variables significantly different between the two groups of subjects were subsequently analyzed using a binary logistic regression to assess their independent contribution to competitive employment in the two patients’ groups. On the basis of the regression results two mediation analyses were performed.
Results
Verbal memory, general psychopathology, and awareness of mental illness were significantly associated with competitive employment in our sample. Both awareness of mental illness and general psychopathology had a role in mediating the verbal memory–competitive employment relationship.
Conclusions
Taken together, these findings confirmed the importance of cognitive function in obtaining competitive employment. Our results also highlighted the independent role of general psychopathology and awareness of illness on occupational functioning in schizophrenia. Thus, a greater attention must be given to the systematic investigation of insight and general psychopathology in light of an amelioration of vocational functioning in stable schizophrenia.
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References
Salkever D, Karakus M, Slade E, Harding C, Hough R, Rosenheck R, Swartz M, Barrio C, Yamada A (2007) Measures and predictors of community-based employment and earnings of persons with schizophrenia in a multisite study. Psychiatr Serv 58:315–324
Bond G, Drake R (2008) Predictors of competitive employment among patients with schizophrenia. Curr Opin Psychiatry 21:362–369
McGurk S, Meltzer H (2000) The role of cognition in vocational functioning in schizophrenia. Schizophr Res 45:175–184
Bush P, Drake R, Xie H, McHugo G, Haslett W (2009) The long-term impact of employment on mental health service use and costs for persons with severe mental illness. Psychiatr Serv 60:1024–1031
RO R (2000) Review of recovery literature: a synthesis of a sample of recovery literature. National Technical Assistance Center for State Mental Health Planning, Alexandra
Bond G, Salyers M, Rollins A, Rapp C, Zipple A (2004) How evidence-based practices contribute to community integration. Community Ment Health J 40:569–588
Lieberman J, Drake R, Sederer L, Belger A, Keefe R, Perkins D, Stroup S (2008) Science and recovery in schizophrenia. Psychiatr Serv 59:487–496
Davidson L, Rowe M, Tondora J, O’Connell MJ, Staeheli Lawless M (2009) A practical guide to recovery-oriented practice. Oxford University Press, New York
Bond G, Resnick S, Drake R, Xie H, McHugo G, Bebout R (2001) Does competitive employment improve nonvocational outcomes for people with severe mental illness? J Consult Clin Psychol 69:489–501
Seeman M (2009) Employment discrimination against schizophrenia. Psychiatr Q 80:9–16
Mc Gurk SR, Mueser KT (2004) Cognitive functioning, symptoms, and work in supported employment: a review and heuristic model. Schizophr Res 70:147–174
Rosenheck R, Leslie D, Keefe R, McEvoy J, Swartz M, Perkins D, Stroup S, Hsiao J, Lieberman J (2006) Barriers to employment for people with schizophrenia. Am J Psychiatry 163:411–417
Lysaker P, Bryson G, Davis L, Bell M (2005) Relationship of impaired processing speed and flexibility of abstract thought to improvements in work performance over time in schizophrenia. Schizophr Res 75:211–218
McGurk S, Mueser K, DeRosa T, Wolfe R (2009) Work, recovery, and comorbidity in schizophrenia: a randomized controlled trial of cognitive remediation. Schizophr Bull 35:319–335
Tsang H, Leung A, Chung R, Bell M, Cheung W (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 Psychiatry 44:495–504
Roy MA, DeVriendt X (1994) Positive and negative symptoms in schizophrenia: a current overview. Can J Psychiatry 39:407–414
Davidson L, McGlashan TH (1997) The varied outcomes of schizophrenia. Can J Psychiatry 42:34–43
Addington J, Addington D (1999) Neurocognitive and social functioning in schizophrenia. Schizophr Bull 25:173–182
Rund BR, Landro NI, Orbeck AL (1997) Stability in cognitive dysfunctions in schizophrenic patients. Psychiatry Res 69:131–141
Addington J, Addington D (2000) Neurocognitive and social functioning in schizophrenia: a 2.5 year follow-up study. Schizophr Res 44:47–56
Brazo P, Marié RM, Halbecq I et al (2002) Cognitive patterns in subtypes of schizophrenia. European Psychiatry 17:155–162
Brazo P, Delamillieure P, Morello R, Halbecq I, Marié RM, Dollfus S (2005) Impairments of executive/attentional functions in schizophrenia with primary and secondary negative symptoms. Psychiatry Res 133:45–55
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(2–3):189–199
Amador X, Strauss D (1993) Poor insight in schizophrenia. Psychiatr Q 64:305–318
David AS (1990) Insight and psychosis. Br J Psychiatry 156:798–808
Lysaker P, Bell M, Milstein R, Bryson G, Beam-Goulet J (1994) Insight and cognitive impairment in schizophrenia. Psychiatry 57:307–315
Lysaker P, Bryson G, Bell M (2002) Insight and work performance in schizophrenia. J Nerv Ment Dis 190:142–146
Simon V, De Hert M, Wampers M, Peuskens J, van Winkel R (2009) The relation between neurocognitive dysfunction and impaired insight in patients with schizophrenia. Eur Psychiatry 24:239–243
Cooke MA, Peters ER, Kuipers E, Kumari V (2005) Disease, deficit or denial? Models of poor insight in psychosis. Acta Psychiatr Scand 112:4–17
Aleman A, Agrawal N, Morgan KD, David AS (2006) Insight and neuropsychological insight neuropsychological function. Br J Psychiatr 189:204–212
Beck AT, Warman DM (2004) Cognitive insight: theory and assessment. In: Amador XF, David AS (eds) Insight and Psychosis. Oxford University Press, New York, pp 79–87
Beck AT, Baruch E, Balter JM, Steer RA, Warman DM (2004) A new instrument for measuring insight: the Beck Cognitive Insight Scale. Schizophr Res 68:319–329
Moritz S, Woodward TS (2006) Specificity of a generalized bias against disconfirmatory evidence (BADE) to schizophrenia. Psychiatry Res 142:157–165
Granholm E, McQuaid JR, McClure FS, Auslander LA, Perivoliotis D, Pedrelli P, Patterson T, Jeste DV (2005) A randomized, controlled trial of cognitive behavioural social skills training for middle-aged and older outpatients with chronic schizophrenia. Am J Psychiatry 162:520–529
Granholm E, Auslander LA, Gottleib JD, McQuaid JR, McClure F (2006) Therapeutic factors contributing to change is cognitive-behavioural group therapy for older persons with schizophrenia. J Contemp Psychother 36:31–41
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR). American Psychiatric Press, Washington, DC
First MB, Gibbon M, Spitzer RL, Williams JBW, Benjamin Smith L (1997) Structured clinical interview for DSM-IV Axis I disorders. American Psychiatric Press, Inc, Washington DC
Razzano L, Cook J, Burke-Miller J, Mueser K, Pickett-Schenk S, Grey D, Goldberg R, Blyler C, Gold P, Leff H, Lehman A, Shafer M, Blankertz L, McFarlane W, Toprac M, Ann Carey M (2005) Clinical factors associated with employment among people with severe mental illness: findings from the employment intervention demonstration program. J Nerv Ment Dis 193:705–713
Kay S, Fiszbein A, Opler L (1987) The positive and negative syndrome scale (panss) for schizophrenia. Schizophr Bull 13:261–276
Amador XF, Strauss DH (1990) The scale to assess unawareness of mental disorder. Columbia University, New York Psychiatric Institute, New York
Delis DC, Kramer JH, Kaplin E, B O (1987) California verbal learning test adult version research edition manual. The Psychological Corporation, New York, NY
Stroop J (1935) Studies of interference in serial verbal reactions. Q J Exp Psychol 18:643–662
Reitan R (1958) Validity of the trial making test as an indicator of organic brain disease. Percept Mot Skills 8:271–276
Heaton RK, Chelune GJ, Kay KK (1993) Winsconsin card sorting test manual. Revised and expanded. Western Psychological Services, Los Angeles, CA
Sartori G, Colombo L, Vallar G, Rusconi ML (1997) T.I.B. Test di intelligenza breve per la valutazione del quoziente intellettivo attuale e pre-morboso. Giornale dell’Ordine degli Psicologi IV
Nelson H.E (1982) National adult reading test: test manual
Baron R, Kenny D (1986) The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol 51:1173–1182
Holmbeck GN (1997) Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. J Consult Clin Psychol 65:599–610
Preacher KJ, Hayes AF (2004) SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput 36:717–731
Campbell K, Bond G, Drake R (2009) Who benefits from supported employment: a meta-analytic study. Schizophr Bull. [Epub ahead of print]
Mueser K, Salyers M, Mueser P (2001) Prospective analysis of work in schizophrenia. Schizophr Bull 27:281–296
Goldberg R, Lucksted A, McNary S, Gold J, Dixon L, Lehman A (2001) Correlates of long-term unemployment among inner-city adults with serious and persistent mental illness. Psychiatr Serv 52:101–103
Nordt C, Müller B, Rössler W, Lauber C (2007) Predictors and course of vocational status, income, and quality of life in people with severe mental illness: a naturalistic study. Soc Sci Med 65:1420–1429
Marwaha S, Johnson S, Bebbington P, Stafford M, Angermeyer M, Brugha T, Azorin J, Kilian R, Hansen K, Toumi M (2007) Rates and correlates of employment in people with schizophrenia in the uk, france and germany. Br J Psychiatry 191:30–37
Catty J, Lissouba P, White S, Becker T, Drake R, Fioritti A, Knapp M, Lauber C, Rössler W, Tomov T, van Busschbach J, Wiersma D, Burns T (2008) Predictors of employment for people with severe mental illness: results of an international six-centre randomised controlled trial. Br J Psychiatry 192:224–231
Cook J, Blyler C, Leff H, McFarlane W, Goldberg R, Gold P, Mueser K, Shafer M, Onken S, Donegan K, Carey M, Kaufmann C, Razzano L (2008) The employment intervention demonstration program: major findings and policy implications. Psychiatr Rehabil J 31:291–295
Cougnard A, Goumilloux R, Monello F, Verdoux H (2009) Characteristics associated with duration of employment of persons with schizophrenia after first contact with psychiatric services. Work 34:365–371
Bellack A, Gold J, Buchanan R (1999) Cognitive rehabilitation for schizophrenia: problems, prospects, and strategies. Schizophr Bull 25:257–274
Gold J, Queern C, Iannone V, Buchanan R (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
Meltzer H, McGurk S (1999) The effects of clozapine, risperidone, and olanzapine on cognitive function in schizophrenia. Schizophr Bull 25:233–255
Velligan D, Bow-Thomas C, Mahurin R, Miller A, Halgunseth L (2000) Do specific neurocognitive deficits predict specific domains of community function in schizophrenia? J Nerv Ment Dis 188:518–524
Gold J, Goldberg R, McNary S, Dixon L, Lehman A (2002) Cognitive correlates of job tenure among patients with severe mental illness. Am J Psychiatry 159:1395–1402
McGurk S, Mueser K, Harvey P, LaPuglia R, Marder J (2003) Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment. Psychiatr Serv 54:1129–1135
Evans J, Bond G, Meyer P, Kim H, Lysaker P, Gibson P, Tunis S (2004) Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia. Schizophr Res 70:331–342
Bryson G, Bell M (2003) Initial and final work performance in schizophrenia: cognitive and symptom predictors. J Nerv Ment Dis 191:87–92
Dickerson F, Boronow J, Stallings C, Origoni A, Cole S, Yolken R (2004) Cognitive functioning in schizophrenia and bipolar disorder: comparison of performance on the repeatable battery for the assessment of neuropsychological status. Psychiatry Res 129:45–53
Hofer A, Baumgartner S, Bodner T, Edlinger M, Hummer M, Kemmler G, Rettenbacher M, Fleischhacker W (2005) Patient outcomes in schizophrenia ii: the impact of cognition. Eur Psychiatry 20:395–402
Dickerson F, Stallings C, Origoni A, Boronow J, 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
Toulopoulouand T, Murray R (2004) Verbal memory deficit in patients with schizophrenia: an important future target for treatment. Expert Rev Neurother 4:43–52
McGurk S, Mueser K, Walling D, Harvey P, Meltzer H (2004) Cognitive functioning predicts outpatient service utilization in schizophrenia. Ment Health Serv Res 6:185–188
Orfei M, Spoletini I, Banfi G, Caltagirone C, Spalletta G (2010) Neuropsychological correlates of cognitive insight in schizophrenia. Psychiatry Res 178:51–56
Lepage M, Buchy L, Bodnar M, Bertrand MC, Joober R, Malla A (2008) Cognitive insight and verbal memory in first episode of psychosis. Eur Psychiatry 23:368–374
McGurk SR, Mueser KT, Pascaris A (2005) Cognitive training and supported employment for persons with severe mental illness: one-year results from a randomized controlled trial. Schizophr Bull 31(4):898–909
Vauth R, Corrigan PW, Clauss M, Dietl M, Dreher-Rudolph M, Stieglitz RD, Vater R (2005) Cognitive strategies versus self-management skills as adjunct to vocational rehabilitation. Schizophr Bull 31:55–66
Greig T, Zito W, Wexler B, Fiszdon J, Bell M (2007) Improved cognitive function in schizophrenia after one year of cognitive training and vocational services. Schizophr Res 96:156–161
McGurk SR, Mueser KT, Feldman K, Wolfe R, Pascaris A (2007) Cognitive training for supported employment: 2–3 year outcomes of a randomized controlled trial. Am J Psychiatry 164:437–441
Lindenmayer JP, McGurk SR, Mueser KT, Khan A, Wance D, Hoffman L, Wolfe R, Xie H (2008) A randomized controlled trial of cognitive remediation among inpatients with persistent mental illness. Psychiatr Serv 59:241–247
Raffard S, Gely-Nargeot M, Capdevielle D, Bayard S, Boulenger J (2009) Learning potential and cognitive remediation in schizophrenia. Encephale 35:353–360
Drake R (2008) Insight into illness: impact on diagnosis and outcome of nonaffective psychosis. Curr Psychiatry Rep 10:210–216
Acknowledgments
This study was supported by a research grant 2006–2167 by Compagnia di San Paolo, Torino, Italy, and a research grant from REGIONE PIEMONTE “Bando Regionale per il finanziamento di Progetti di Ricerca Sanitaria Finalizzata, 2007”.
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Giugiario, M., Crivelli, B., Mingrone, C. et al. Cognitive function and competitive employment in schizophrenia: relative contribution of insight and psychopathology. Soc Psychiatry Psychiatr Epidemiol 47, 553–561 (2012). https://doi.org/10.1007/s00127-011-0367-7
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DOI: https://doi.org/10.1007/s00127-011-0367-7