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Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study

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Abstract

Background

Employment rates among people with severe mental illness are low and work has beneficial effects on mental health. There is now good evidence of the effectiveness of a specialist vocational intervention (supported employment) in people with schizophrenia. However, the potential benefits of modifying this model for use in first episode psychosis cohorts remain relatively untested.

Methods

The aim of our study was to evaluate the effectiveness of a specialist vocational intervention in aiding vocational recovery following the onset of first episode psychosis. In a naturalistic prospective cohort study, 114 first episode psychosis service users were followed up during 12 months of engagement with an early intervention service; 44 resident in an area where a vocational intervention was available and 70 in an area where it was not.

Results

The main finding in our study was that having access to the specialist vocational intervention was a statistically significant independent predictor of vocational recovery during 12 months of follow-up (after adjusting for confounders). Service users who had access to the intervention had odds of achieving vocational recovery 3.53 times greater than those who did not (OR = 3.53, 95% CI = 1.25–10.00).

Conclusion

This study provides further preliminary evidence of the effectiveness of a specialist vocational intervention following first episode psychosis. This is an important outcome from the perspective of service users and clinicians alike (as well as having wider societal value). Other important predictors of vocational recovery cannot be modified by the time a first episode psychosis emerges.

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References

  1. Boardman J (2003) Work, employment & psychiatric disability. Adv Psychiatr Treat 9:327–334

    Article  Google Scholar 

  2. Boardman J, Grove B, Perkins R, Shepherd G (2003) Work and employment for people with psychiatric disabilities. Br J Psychiatr 182:467–468

    Article  Google Scholar 

  3. Bond GR (2004) Supported employment: evidence for an evidence based practice. Psychiatr Rehabil J 27:345–359

    Article  PubMed  Google Scholar 

  4. Burns T, Catty J, White S, Becker T, Koletsi M, Fioritti A, Rossler W, Tomov T, van Busschbach J, Wiersma D, Lauber C; for the EQOLISE Group (2008) The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support. Schizophr Bull [Epub ahead of print]

  5. Crowther R, Marshall M, Bond G, Huxley P (2001) Vocational rehabilitation for people with severe mental illness. Cochrane database of systematic reviews Issue 2. Art. No.: CD003080

  6. Department of Health (2001) The mental health policy implementation guide. Department of Health, London

    Google Scholar 

  7. Endicott J, Spitzer RL, Fleiss JL, Cohen J (1976) The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Arch Gen Psychiatry 33:766–771

    CAS  PubMed  Google Scholar 

  8. Fisher H, Theodore K, Power P, Chisholm B, Fuller J, Marlowe K, Aitchison KJ, Tanna R, Joyce J, Sacks M, Craig T, Johnson S (2008) Routine evaluation in first episode psychosis services: feasibility and results from the MiData project. Soc Psychiatry Psychiatr Epidemiol 43:960–967

    Article  PubMed  Google Scholar 

  9. Harris MG, Henry LP, Harrigan SM, Purcell R, Schwartz OS, Farrelly SE, Prosser SL, Jackson HJ, McGorry PD (2005) The relationship between duration of untreated psychosis and outcome: an eight year prospective study. Schizophr Res 79:85–93

    Article  PubMed  Google Scholar 

  10. Jeppesen P, Abel M, Thorup A, Peterson L, Ohlenschlaeger J, Christensen TO, Krarup G, Jorgensen P, Nordentoft M (2006) Association between premorbid functioning, duration of untreated psychosis and two-year outcome in first episode psychosis [abstract]. Schizophr Res 86(Suppl 1):s43

    Article  Google Scholar 

  11. Kay SR, Opler LA, Fiszbein A (1992) Positive and negative syndrome scale (PANSS): manual. Multi-Health Systems Inc, New York

    Google Scholar 

  12. Killackey EJ, Jackson HJ, Gleeson J, Hickie IB, McGorry PD (2006) Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first episode psychosis: employing cautious optimism. Aust NZ J Psychiatry 40:951–962

    Google Scholar 

  13. Killackey EJ, Jackson HJ, McGorry PD (2008) Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. Br J Psychiatry 193:114–120

    Article  PubMed  Google Scholar 

  14. Leucht S, Kane JM, Kissling W, Hamann J, Etschel E, Engel RR (2005) What does the PANSS mean? Schizophr Res 79:231–238

    Article  PubMed  Google Scholar 

  15. Malla A, Payne J (2001) First episode psychosis: psychopathology, quality of life, and functional outcome. Schizophr Bull 31:650–671

    Article  Google Scholar 

  16. Marshall M, Lewis S, Lockwood A, Drake R, Jones P, Croudace T (2005) Association between duration of untreated psychosis and outcome in cohorts of first episode patients. Arch Gen Psychiatry 62:975–983

    Article  PubMed  Google Scholar 

  17. Marwaha S, Johnson S (2004) Schizophrenia and employment. Soc Psychiatry Psychiatr Epidemiol 39:337–349

    Article  PubMed  Google Scholar 

  18. Marwaha S, Johnson S (2005) Views and experiences of employment among people with psychosis: a qualitative descriptive study. Int J Soc Psychiatry 51:302–316

    Article  PubMed  Google Scholar 

  19. Marwaha S, Balachandra S, Johnson, S (2008) Clinicians attitudes to the employment of people with psychosis. Soc Psychiatry Psychiatr Epidemiol [Epub ahead of print]

  20. Milev P, Ho B, Arndt S, Andreason 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 

  21. Norman RMG, 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 91:259–262

    Article  PubMed  Google Scholar 

  22. Office for National Statistics (2006) Annual population survey. Office for National Statistics, Newport

    Google Scholar 

  23. 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 162:1785–1804

    Article  PubMed  Google Scholar 

  24. 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

    Article  Google Scholar 

  25. Rinaldi M, Perkins R, Glynn E, Montibeller T, Clenaghan M, Rutherford J (2008) Individual placement and support: from research to practice. Adv Psychiatr Treat 14:50–60

    Article  Google Scholar 

  26. Simonsen E, Friis S, Haahr U, Johannesen JO, Larsen TK, Melle I, Opjordsmoen SI, Rund BR, Vaglum P, McGlashen TH (2006) Two year outcome and predictors in first episode psychosis [abstract]. Schizophr Res 86(Suppl 1):s155

    Article  Google Scholar 

  27. Singh SP, Cooper JE, Fisher HL, Tarrant CJ, Lloyd T, Banjo J, Corfe S, Jones P (2005) Determining the chronology and components of psychosis onset: the Nottingham onset schedule (NOS). Schizophr Res 80:117–130

    Article  PubMed  Google Scholar 

  28. Sturm R, Gresenz CR, Pacula RL, Wells KB (1999) Labour force participation by persons with mental illness. Psychiatr Serv 50:1407

    CAS  PubMed  Google Scholar 

  29. Tsang HWH, Angell B, Corrigan PW, Lee Y, Shi K, Lam CS, Jin S, Fung KMT (2007) A cross-cultural study of employers’ concerns about hiring people with psychotic disorder: implications for recovery. Soc Psychiatry Psychiatr Epidemiol 42:723–733

    Article  PubMed  Google Scholar 

  30. Tulloch AD, Fearon P, David AS (2006) Social outcomes in schizophrenia: from description to action. Curr Opin Psychiatry 19:140–144

    Article  PubMed  Google Scholar 

  31. Turkington AJ, Rushe TM, Cooper SJ, Anderson R, McCaul R, Barrett SL, Mulholland C (2006) Clinical predictors of one year outcome in patients with first episode psychosis [abstract]. Schizophr Res 86(Suppl 1):s153

    Article  Google Scholar 

  32. Vyas NS, Vourdas A, Byrne P, Frangou S (2006) The Maudsley early onset schizophrenia study: predictors of psychosocial outcome at 4-year follow-up (abstract). Schizophr Res 86(Suppl 1):s159

    Article  Google Scholar 

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Acknowledgments

We acknowledge the hard work and commitment of the Camden & Islington Early Intervention Service clinical team in collecting and entering the data. Joanna Morrison, Occupational Therapist, played a major role in the development of the VIBE service.

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Authors and Affiliations

  1. EQUIP, 176-178 Clapton Common, Hackney, London, E5 9AG, UK

    Barnaby S. Major

  2. Camden and Islington Early Intervention Service, 125-133 Bedford House, Camden High Street, London, NW1 7JR, UK

    Mark F. Hinton, Amy Flint, Anna Chalmers-Brown, Katharine McLoughlin & Sonia Johnson

  3. Research Department of Clinical, Educational and Health Psychology, University College London, 1-19 Torrington Place, London, WC1E 7HB, UK

    Anna Chalmers-Brown & Katharine McLoughlin

  4. Department of Mental Health Sciences, University College London, 3rd Floor Charles Bell House, 67-73 Riding House St, London, W1W 7EJ, UK

    Sonia Johnson

Authors
  1. Barnaby S. Major
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  2. Mark F. Hinton
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  3. Amy Flint
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  4. Anna Chalmers-Brown
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  5. Katharine McLoughlin
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  6. Sonia Johnson
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Correspondence to Barnaby S. Major.

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Major, B.S., Hinton, M.F., Flint, A. et al. Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: a naturalistic prospective cohort study. Soc Psychiat Epidemiol 45, 1–8 (2010). https://doi.org/10.1007/s00127-009-0034-4

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  • DOI: https://doi.org/10.1007/s00127-009-0034-4

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