The 312 patients who participated in the study were recruited from a total pool of 1036.16
Data on the primary outcome measure (in competitive employment for at least 1 day) were available for the whole sample (312). Of these, 252 (80.8%) completed the final follow-up interview. There were no statistically significant differences between people who dropped out of the study (did not complete T3 research interview) and those who remained in the study in terms of psychopathology, global functioning, sociodemographic characteristics (age, gender, education, country of residence, work history), and illness characteristics (age at first contact with psychiatric services, number of lifetime admissions, clinical diagnosis) (data not shown, on request with the first author).
The majority of the sample had a diagnosis of schizophrenia (80.3%) and were male (60.3%), while 55.8% had worked for more than a month in the previous 5 years.16
Baseline clinical and social functioning variables are presented in .
Clinical and Social Functioning Outcomes at Baseline, by Service—Mean (SD), Minimum–Maximum
Differences in clinical and social functioning between the IPS and Vocational Service Groups
shows that there were no significant differences between patients who received IPS and those who received the vocational services at the final follow-up (T3) in terms of clinical and social functioning outcomes. The vocational service patients were twice as likely as the IPS patients to have been hospitalized in the last 6 months of the study, but this only approached statistical significance (P = 0.059).
Clinical and Social Functioning Outcomes at T3, by IPS/Control—Mean (SD) Unless Otherwise Stated
When patients who had worked were considered separately, only social functioning differed significantly between the IPS and vocational service groups, with IPS patients having GSDS total scores higher by 1.61 points (out of 21). To explore further this difference in total GSDS score, the 8 subscales were then analysed separately. There were statistically significant differences between IPS and vocational service patients on the “self-care,” “partner,” and “citizen” subscales, although the magnitude of each difference was very small. (Data on request from the first author.)
Associations Between Working and Clinical and Social Functioning Outcomes at Final Follow-up
Associations Between Having Worked and Outcomes.
As shows, patients who worked during the 18-month study period had significantly better global functioning in terms of symptoms and disability, fewer negative and general symptoms, and less social disability at T3 than those who had not worked. Patients who had worked were also more likely to be in remission for the last 6-month period of the study, although this was only of borderline significance. To explore the differences in social disability, the 8 subscales of the GSDS were analysed separately. There were statistically significant differences between the 2 groups on the “family,” “citizen,” “social,” and “occupation” subscales, all of a small magnitude, with the greatest being a difference of 0.7 points (out of 4) on the “occupation” subscale, all in favor of those who had worked. (Data from first author on request.)
Clinical and Social Functioning Outcomes at T3, by Worked/Not Worked, Days Worked, and Job Tenure
Associations Between Total Duration of Work and Outcomes.
When the analysis was repeated using the total duration of work (“days worked”) as the independent variable, there were small but significant associations between days worked and global functioning in terms of symptoms and disability, negative symptoms, general symptoms, and social disability. Working for 90 days more was associated with better global functioning in terms of symptoms (by 1.8 points out of 100 on GAF-S), better global functioning in terms of disability (by 2.7 points out of 100 on GAF-D), fewer negative symptoms (by 0.9 points out of 42 on PANSS), fewer general symptoms (by 0.9 points out of 42 on PANSS), and less social disability (by 0.9 points out of 21 on GSDS). Whether the patient had been hospitalized in the final 6 months of the study also approached significance: working for 90 days more reduced the odds of being hospitalized in the final 6 months of the study by 18% ().
Associations Between Job Tenure and Outcomes.
When job tenure was analysed for only those patients who worked, it was associated only with global functioning in terms of disability. Holding the longest job for 90 days more was associated with better global functioning in terms of disability (by 1.8 points out of 100 on GAF-D) ().
Associations Between Working and Concurrent Clinical and Social Functioning
demonstrates that there were significant differences between those currently working and those not working in all the outcomes measured apart from anxiety, depression, and positive symptoms. Being in work was concurrently associated with having better global functioning in terms of symptoms and disability, with GAF-S and GAF-D scores 2.8 and 6.9 points higher (95% CI = 1.06 to 4.52, 5.27 to 8.60), respectively; with fewer general symptoms, with scores 1.6 points lower (95% CI = 0.48 to 2.74); with less social disability, with total GSDS scores 1.38 points lower (95% CI = 0.88 to 1.89); and with better subjective quality of life, with LQoLP scores 0.26 points higher (95% CI = 0.14 to 0.37). Patients not currently working were also 2.84 times as likely to have been hospitalized in the previous 6 months (95% CI = 1.22 to 8.70) and 1.98 times as likely to be in remission for the previous 6 months (95% CI = 1.15 to 3.40).
Association Between Currently Working With Clinical and Social Functioning Variables
When this analysis was performed for the 2 service groups separately, differences between those working and those not working were consistently greater within the vocational services group than within the IPS group. Thus, while working was associated with having better functioning and being less symptomatic, as already demonstrated, these differences were greater for those receiving vocational services.
Associations Between Working and Subsequent Clinical and Social Functioning
As shows, being in work at any time point (T0–T2) was associated with a statistically significant decrease in depression over the subsequent 6 months, although this was of small magnitude (those working having a significant reduction in symptoms by 0.75 points on HADS), while not working was not significantly associated with any change in depression. The difference between the 2 groups was of borderline significance. It was also associated with being in remission for the subsequent 6 months (those in work being 2.3 times as likely to be in remission). There was no significant association with change in any other clinical and social functioning outcomes over the subsequent 6 months nor with being hospitalized in the subsequent 6 months.
Association between current working and change over subsequent 6 months in clinical and social functioning outcomes