Predictors of competitive employment in individuals with severe mental illness: results from an observational, cross-sectional study in Germany

BACKGROUND: Employment is of great importance as it is associated with various positive effects. Individuals with severe mental illness (SMI) are often excluded from competitive employment. Current data on employment of individuals with mental illness are rare, and influencing factors are under-researched. The present study examines possible predictors of competitive employment among individuals with SMI. METHODS: This was a cross-sectional and multicentered study of 300 individuals with SMI aged 18 to 65 years. The following inclusion criteria were used: (I) diagnosis of schizophrenia, schizotypal and delusional disorders (ICD-10 F2x), or affective disorders (ICD-10 F3x), (II) duration of psychiatric illness ≥ 2 years, and (III) substantial impact of illness on social functioning. Participants were interviewed by trained staff using standardised instruments. The relationship between potential predictors (age, sex, education, marital status, living situation, migration background, psychosocial functioning, age at first mental problem, physical illness, work ability) and employment was analysed using a hierarchic binary logistic regression model. RESULTS: Only one-third (34%) of participants were competitively employed. Almost one-third were unemployed (30%), and 28% reported early retirement due to mental illness. Psychosocial functioning was positively associated with competitive employment (OR = 1.09, 95% CI: 1.05 – 1.13, p < 0.001); concurrent chronic physical illness was negatively associated with competitive employment (OR = 0.38, 95% CI: 0.21 – 0.71, p = 0.002). CONCLUSIONS: Findings confirm a high risk of exclusion from competitive employment among individuals with SMI. Nonetheless, a substantial proportion of individuals are employed. Findings call for efforts to maintain or enhance workforce participation among individuals with SMI. A special focus should be placed on improving physical health and strengthening psychosocial functioning. TRIAL REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019)

Employment status and desire for work in severe mental illness: results from an observational, cross-sectional study

PURPOSE: People with a severe mental illness (SMI) are at particular risk of occupational exclusion. Among the approaches to occupational rehabilitation, supported employment (SE) has been proven to be the most effective. A requirement to enter SE-programs is that individuals must want to seek competitive employment. The aim of this work is to investigate the relationship between serious mental illness and the desire to work including potential predictors. METHODS: This is a cross-sectional observational study of patients with SMI aged 18–65 years (n = 397). Patients were interviewed by trained staff using standardised instruments. The relationship between potential predictors and a strong preference for employment were analysed using a hierarchic binary logistic regression model. RESULTS: Only about one-quarter (27.9%) of SMI patients is in competitive employment. Another quarter is unemployed (25.9%). Results show that the desire for competitive employment is strong among more than half of the SMI patients. Among the unemployed, two-thirds express a strong desire for work. These individuals are an ideal target group for SE interventions. Comorbid chronic physical illness, diagnosis, and the subjectively judged ability to work are associated with the desire for work. CONCLUSION: Our data confirm a substantial exclusion of individuals with SMI from the workforce. In general, care needs for workplace interventions are not being met and leave much room for improvement. In addition to employment status, the desire for work should be routinely assessed. STUDY REGISTRATION: The study was registered in the German Clinical Trials Register (DRKS) (https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015801) and under the WHO-Platform “International Clinical Trials Registry Platform” (ICTRP) (https://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00015801) under the registration number DRKS00015801 before the start of recruitment (Registration date: 21.02.2019)

The role of migration in mental healthcare: treatment satisfaction and utilization

Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare. In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients’ satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients’ needs were measured via CAN-EU. In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment). Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12888-022-03722-8

Spatial distribution of cannabinoid receptor type 1 (CB1) in normal canine central and peripheral nervous system.

The endocannabinoid system is a regulatory pathway consisting of two main types of cannabinoid receptors (CB1 and CB2) and their endogenous ligands, the endocannabinoids. The CB1 receptor is highly expressed in the central and peripheral nervous systems (PNS) in mammalians and is involved in neuromodulatory functions. Since endocannabinoids were shown to be elevated in cerebrospinal fluid of epileptic dogs, knowledge about the species specific CB receptor expression in the nervous system is required. Therefore, we assessed the spatial distribution of CB1 receptors in the normal canine CNS and PNS. Immunohistochemistry of several regions of the brain, spinal cord and peripheral nerves from a healthy four-week-old puppy, three six-month-old dogs, and one ten-year-old dog revealed strong dot-like immunoreactivity in the neuropil of the cerebral cortex, Cornu Ammonis (CA) and dentate gyrus of the hippocampus, midbrain, cerebellum, medulla oblongata and grey matter of the spinal cord. Dense CB1 expression was found in fibres of the globus pallidus and substantia nigra surrounding immunonegative neurons. Astrocytes were constantly positive in all examined regions. CB1 labelled neurons and satellite cells of the dorsal root ganglia, and myelinating Schwann cells in the PNS. These results demonstrate for the first time the spatial distribution of CB1 receptors in the healthy canine CNS and PNS. These results can be used as a basis for further studies aiming to elucidate the physiological consequences of this particular anatomical and cellular distribution

Are cytokine profiles associated with the cognitive performance of adults with severe major depression?

Cognitive impairment often occurs in major depressive disorder (MDD). Studies suggest that these cognitive deficits may be associated with inflammatory biomarkers, but data are limited. Therefore, this study aims to investigate the relationship between 48 peripheral blood cytokines and cognitive performance in patients with severe depressive disorder. One hundred consecutive hospitalized adult patients with severe depression who participated in the Depression long-term Augsburg (DELTA) study were included in the present analysis. To test working memory (WM) the Wechsler Adult Intelligence Scale (WAIS) IV and to assess interference control (IC) the Stroop Color and Word Test (SCWT) were performed. The serum concentrations of the biomarkers were measured using the Bio-Plex Pro™ Human Cytokine Screening Panel 1. Multiple linear regression models adjusted for possible confounders were fitted to examine associations. WM was impaired in 11% of the patients. IC was impaired in 1%–3% of the cases depending on the subtest. Eotaxin, IL-1β, IL-4, MCP-1, G-CSF, and PGF-BB were negatively associated with the WM. Eotaxin, IL-1β, IL-4, IL-16, IL-18, MCP-1, G-CSF, SCF, and MIP-1α were negatively associated with IC. None of these associations remained significant after adjustment for multiple testing. The present study identified eotaxin, IL-1β, IL-4, IL-16, IL-18, MCP-1, G-CSF, SCF, PGF-BB and MIP-1α as being associated with cognitive performance. After confirmation of these results in further studies, these cytokines may be potential targets for new treatments

Double immunofluorescence staining of the cerebral white matter of a six-month-old Beagle dog.

<p>Double immunofluorescence staining of CB₁ (green, A) with GFAP (red, B) reveals co-localization in about 20% astrocytes (C). CNPase expression (red, E) and CB₁ (green, D) do not co-localize, suggesting a lack of expression of CB₁ receptors by mature oligodendrocytes (F). Nuclear staining (blue) with bisbenzimide.</p

CB₁ immunoreactivity of the Olfactory bulb.

<p>CB₁ immunoreactivity of a six-month-old Beagle dog (A, B, C) and four-week-old dog (D). Strong immunoreactivity of the glomerular layer (GL), lack of immunoreactivity in the external plexiform layer (EPL) and mitral cell layer (ML), while moderate immunoreactivity of the internal plexiform layer (IPL) are observed in the six-month-old Beagle dog (A). Detailed immunoreactivity of the GL (arrow) is depicted in B. In the six-month-old Beagle dog, a population of cells within the internal granule cell layer (arrow) is strongly CB₁ receptor positive (C). Contrary, the glomerular layer in the four-week-old dog was only slightly CB₁ receptor positive (D). IHC was performed using the avidin-biotin-peroxidase complex (ABC) method.</p

CB₁ immunoreactivity of the cerebellum and choclear nuclei.

<p>In figure A notice strong CB₁ immunoreactivity within the molecular layer of the cerebellar cortex in a six-month-old Beagle dog. Figure B depicting in detail immunonegative Purkinje cells surrounded by strong immunorreactive fibers particularly in the basal portion (arrow). In the ten-year-old dog, there is a slight immunoreactivity in the molecular layer of the cerebellar cortex (C). Purkinje cells surrounded by a dot-like immunoreactivity appear devoid of immunoreactivity in the ten-year-old dog (D; arrow). The cochlear nucleus in a six-month-old dog showing strong CB₁ immunoreactivity (E). In figure F detail of the cochlear nucleus with strong CB₁ immunoreactivity surrounding the unstained neuronal bodies (arrow). IHC was performed using the avidin-biotin-peroxidase complex (ABC) method.</p

CB₁ immunoreactivity in the spinal cord, dorsal root ganglia and peripheral nerve.

<p>In figure A, strong CB₁ immunoreactivity is shown in the grey matter of the cervical spinal cord of a six-month-old dog and the cytoplasm of ependymal cells lining the central canal (A; arrow). Within the dorsal horn, CB₁ immunoreactivity appears surrounding unstained neuronal bodies (B; arrow). In the cervical spinal cord of a ten-year-old dog notice slight immunoreactivity of the grey matter (C). Figure D showing the cervical dorsal root ganglia of a six-month-old dog with slight immunoreactivity of large neurons and strong CB₁ immunoreactivity of small dark neurons (arrows) and satellite cells (arrowheads). The thoracic dorsal root ganglia of a ten-year-old dog with moderate CB₁ immunoreactivity of small dark neurons and satellite cells, large neurons show slight immunoreactivity (E; arrow). The cervical dorsal root ganglia of a four-week-old dog depicting scattered large and small neurons and satellite cells with slight CB₁ immunoreactivity (F; arrow). In figure G the cervical spinal nerve of a six-month-old dog shows strong CB₁ expression in Schwann cells ensheating axons (arrow). Few Schwann cells show moderate CB₁ immunoreactivity (arrow) in a thoracic spinal nerve of a ten-year-old dog (H). The cervical spinal nerve in the four-week-old dog shows moderate CB₁ immunoreactivity of scattered Schwann cells (I; arrow). IHC was performed using the avidin-biotin-peroxidase complex (ABC) method.</p

Double immunofluorescence staining of the sciatic nerve of a six-month-old dog.

<p>P0, a marker for myelinating Schwann cells (red, B) and CB₁ (green, A) co-localize in about 100% of Schwann cells (C). p75^NTR (red, E) and CB₁ (green, D) do not co-localize (F), suggesting the absence of CB₁ receptors in non-myelinating Schwann cells. Nuclear staining (blue) with bisbenzimid.</p