Predictors and course of vocational status, income, and quality of life in people with severe mental illness: a naturalistic study.

Full Abstract

Due to high unemployment rates, people with mental illness are at risk of poverty and are deprived of the social and psychological functions of work, such as the provision of social support, structuring of time, and self-esteem, with a negative effect on their perceived quality of life (QoL). Two distinct processes are held responsible for the low work force participation of people with mental illness:
'Social underachievement' and 'social decline'. Social underachievement signifies that, due to early illness onset, the educational attainment of people with mental illness is low and entry to the labor market fails. Social decline, on the other hand, describes the loss of competitive employment after illness onset, followed by prolonged periods of unemployment and difficulties to re-enter the labor market. This study examines how social underachievement and decline are reflected in the course of vocational status, income, and QoL of people with severe mental illness in the years after a psychiatric admission in a naturalistic longitudinal design. A total of 176 participants diagnosed with schizophrenia or affective disorders were interviewed during an index hospitalization in two large psychiatric hospitals in Zurich. Follow-up interviews were conducted 12 and 30 months after. Random coefficient models (multilevel models) were used to examine simultaneously the predictors and course of the variables of interest. A low number of psychiatric hospitalizations, a higher educational degree, a diagnosis of schizophrenia, and years of work experience predicted a higher vocational status. Vocational status decreased in first-admission participants with prolonged hospitalizations during the follow-up period. Income did not change over time and was positively influenced by a higher age of illness onset, competitive employment, higher education, and not having had a longer hospitalization recently. Subjective QoL significantly improved and was rated higher by people with any kind of employment than by participants without a job. Participants with an affective disorder, those with few hospitalizations but a recent inpatient stay of longer duration, showed lower QoL. Including employment issues early in treatment is especially important for people with an early illness onset and those with more severe forms of psychiatric disorder. A life course perspective enhances the understanding of patients' vocational potential and needs for support.

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Author information

Author/s: Nordt, Carlos (C); Müller, Brigitte (B); Rössler, Wulf (W); Lauber, Christoph (C);

Affiliation: Psychiatric University Hospital Zurich, Zurich, Switzerland. cnordt@bli.unizh.ch

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Social science & medicine (1982) (Soc Sci Med), published in England. (Language: eng)

Reference: 2007-Oct; vol 65 (issue 7) : pp 1420-9

Dates: Created 2007/09/03; Completed 2008/01/17;

PMID: 17583402, status: MEDLINE (last retrieval date: 11/6/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Adult
Age of Onset
Employment - psychology; statistics & numerical data
Female
Hospitals, Psychiatric
Humans
Longitudinal Studies
Male
Middle Aged

Mood Disorders - diagnosis; rehabilitation
Patient Admission
Quality of Life
Questionnaires
Rehabilitation, Vocational
Schizophrenia - diagnosis; rehabilitation
Sickness Impact Profile
Switzerland
Underachievement

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