Long-term employment among people at ultra-high risk for psychosis
Introduction
Psychotic disorders such as schizophrenia are associated with high rates of sustained unemployment (Marwaha and Johnson, 2004, Marwaha et al., 2007, Waghorn et al., 2012). In an effort to reduce this, there is a growing international consensus that vocational support should be offered for these patients (Kreyenbuhl et al., 2010, National Institute for Health and Care Excellence, 2014, Galletly et al., 2016). In England, mental health services are now required to assist patients with first-episode psychosis to engage in employment, education or training as part of the new ‘Early Intervention in Psychosis Access and Waiting Time standards’ (NHS England, 2016). As well as reducing the high societal cost of these disorders (Knapp et al., 2004), employment is thought to improve the general wellbeing of people with psychosis and is widely considered to be an important aspect of recovery (Rinaldi et al., 2010, Ramsay et al., 2011).
In contrast, little is known about the long-term employment outcome of young people who are at ultra-high risk (UHR) of developing a psychotic disorder (Yung et al., 1996, Yung et al., 1998, Fusar-Poli et al., 2013a). This is a group for whom similar provision of resources may be important. At presentation to services, UHR patients are significantly more likely to be unemployed compared to their peers (Fusar-Poli et al., 2010), with reports suggesting up to 46% are not in employment, education or training (Fusar-Poli et al., 2013b). However, data on employment outcome in this population is limited to only a few short-term follow-up studies (Velthorst et al., 2011, Salokangas et al., 2013). To our knowledge, no studies have examined the long-term unemployment rate or baseline predictors of employment outcome in the UHR group.
The aims of the current study were;
- 1.
To examine the rate of unemployment among a large UHR cohort at long-term follow-up
- 2.
To determine which clinical and demographic baseline variables were the strongest predictors of employment status at follow-up
Section snippets
Participants
The current data are part of a longitudinal study that aimed to reassess all UHR individuals who took part in research at the PACE (Personal Assessment and Crisis Evaluation) clinic in Melbourne, Australia between 1993 and 2006 (n = 416). At baseline, participants were aged 15–30 years and met UHR criteria rated according to the Comprehensive Assessment of At-Risk Mental States (CAARMS; Yung et al., 2005). Follow-up assessments were conducted between 2007 and 2009. The full sample has been
Employment rate
At follow-up, 92 individuals (34.3%) were in full-time employment, 58 (21.6%) were employed part-time or as casual workers, 34 (12.7%) were students, 22 (8.2%) identified as homemakers and 62 (23.1%) were unemployed.
Group differences at baseline and follow-up
Group differences at baseline and follow-up between those categorised as ‘Employed’ (n = 184) or ‘Unemployed’ (n = 62) at follow-up are provided in Table 1. At baseline, those who were unemployed at follow-up had a longer DUI, more severe negative symptoms, lower IQ, and reported more
Summary of results
Almost a quarter of UHR participants recruited and followed-up from the PACE clinic were unemployed on average seven years after presenting to the service. Although this is a much lower figure compared to the unemployment rate reported among individuals with full-threshold psychotic disorders both in Australia and internationally (Marwaha et al., 2007, Waghorn et al., 2012), it is still a considerable proportion of young people and represents a potential target for intervention. Childhood
Conflict of interest
Professor Yung has received a research grant from Janssen-Cilag, honoraria from Janssen-Cilag, Sunovion and Otsuka. Professor McGorry has received funding from AstraZeneca, Eli Lilly, Janssen-Cilag, Pfizer, and Novartis, and honoraria from AstraZeneca, Eli Lilly, Janssen-Cilag, Pfizer, Bristol-Myers Squibb, Roche, and the Lundbeck Institute. The other authors report no financial relationships with commercial interests.
Contributors
JC, AY, RD conception of the paper. JC, RD statistical analyses. JC, AY, AL, RD, AT, BN, PM, SW interpretation of the data. JC initial drafting of the manuscript. JC, AY, AL, RD, AT, BN, PM, SW critical revision of the manuscript. JC, AL, RD, AT, BN, PM, SW, AY approval of the manuscript for publication.
Funding
This work was supported by National Health and Medical Research Council (NHMRC) programme grants (350241 and 566529) to A.R.Y., S.J.W. and P.M., the Colonial Foundation, and an unrestricted research grant from Janssen-Cilag. A.R.Y., S.J.W. and B.N. were supported by NHMRC Awards and B.N. by a Griffith Fellowship. A.R.Y. and P.M. also received grant funding from NARSAD. A.L. is currently supported by an NHMRC Award (no. 1072593). P.M. is currently supported by an NHMRC Senior Principal Research
Acknowledgements
None.
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