Explaining the rates and correlates of employment in people with schizophrenia.

Abstract

Background: Access to employment is poor for many people with schizophrenia despite their wish to work and we are only beginning to understand why.;Aims: 1. To evaluate the current literature on the rates and correlates of employment in people with schizophrenia and the barriers to working. 2. To explore the extent to which people with schizophrenia living in the U.K., France and Germany work. 3. To explore the associations of having a job, getting a job and losing a job in people with schizophrenia living in the U.K. France and Germany. 4. To investigate whether employment status influences non-vocational outcomes. 5. To explore the views about working amongst people with severe mental illness. 6. To examine staff attitudes to people with psychosis working.;Methods: For aim 1, a literature review was completed using the PsychINFO, Embase, Medline and Web of Science Databases. Aims 2-6 were addressed using a variety of study designs. These were: quantitative analysis of data from the EuroSC study, a 2 year prospective naturalistic study of people with schizophrenia (N=1208) living in the U.K, France and Germany a thematic analysis of semi-structured interviews with people with SMI a survey of clinicians working in CMHTs.;Results: Aim 1 Rates of employment amongst people with schizophrenia are low. A number of socio-demographic and clinical correlates of employment and barriers to working are described. Aim 2, 3 and 4 People with schizophrenia are able to work in all sections of the job market. Clinical, social and area-level factors have an influence on work status. Employment status may have an affect on other outcomes. Aim 5 Participants identified advantages to working but also expressed substantial doubts. Aim 6 Clinicians suggested that many more people with psychosis were capable of working than were actually doing so.;Conclusions: Unemployment appears to be the consequence of an interplay between the biological and social situations of service users and societal factors that affect their choices and efforts. Promisingly this also means that there are multiple points at which interventions might be effective in helping people to work