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Predictors of employment status change over 2 years in people with schizophrenia living in Europe

  • Steven Marwaha (a1), Sonia Johnson (a1), Paul E. Bebbington (a1), Matthias C. Angermeyer (a2), Traolach S. Brugha (a3), Jean-Michel Azorin (a4), Reinhold Killian (a5), Karina Hansen (a6) and Mondher Toumi (a7)...


Aim – To examine the associations of job acquisition and loss in a representative, prospective community sample of people with schizophrenia living in the UK, France and Germany. Method – A representative sample of twelve hundred and eight people with schizophrenia were recruited from selected secondary mental health services in the U.K, France and Germany and followed up for 2 years. Information on demographic details, psychotic symptoms and work status was collected. Results – The odds of getting jobs were increased by being resident in Marseille, Leipzig, Hemer and Heilbronn and by a higher regional general population employment rate. The odds were reduced by living in Lyon, a later illness onset, a longer length of illness, a continuous illness course and more severe negative psychotic symptoms. Previous vocational training reduced the odds of losing employment, whilst living in Lyon or Leipzig, harmful use of alcohol and more positive psychotic symptoms at baseline all increased the odds. Conclusions – In addition to illness related factors, area of residence and local labour market conditions appear to be important in explaining employment status change in people with schizophrenia.

Declaration of Interest: All authors declare there are no conflicts of interest. This study was funded by grants from Lundbeck A/S and from the German Federal Ministry of Education and Research.


Corresponding author

Address fo correspondence: Dr. S. Marwaha, Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry, CV4 7AL (United Kingdom). Fax: +44-(0)24-7652.8375, E-mail:


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Amminger, G.P., Edwards, J., Brewer, W.J., Harrigan, S. & McGorry, P.D. (2002). Duration of untreated psychosis and cognitive deterioration in first episode schizophrenia. Schizophrenia Research 54, 223230.
Barnes, T.R.E., Hutton, S.B., Chapman, M.J., Mutsatsa, S., Puri, B.K. & Joyce, E.M. (2000). West London first-episode study of schizophrenia: Clinical correlates of duration of untreated psychosis. British Journal of Psychiatry 177, 207211.
Bartley, M. (1994). Unemployment and ill health: Understanding the relationship. Journal of Epidemiology and Community Health, 48, 333337.
Bebbington, P., Angermeyer, M., Azorin, J.-M., Brugha, T., Kilian, R., Johnson, S. & Toumi, M. (2005). The European Schizophrenia Cohort (EuroSC): a naturalistic prognostic and economic study. Social Psychiatry and Psychiatric Epidemiology 40, 707717.
Becker, D. & Drake, R.E. (2001). A Working Life. Oxford University Press: New York.
Becker, D.R., Drake, R.E., Bond, G.R., Xie, H., Dain, B.J. & Harrison, K. (1998). Job terminations among persons with Severe Mental Illness participating in Supported Employment. Community Mental Health Journal 34, 7182.
Birchwood, M., Jackson, C. & Fowler, D. (2000). Early Intervention in Psychosis: A Guide to Concepts, Evidence and Interventions. John Wiley: Chichester, UK.
Bond, G.R. (2004). Supported employment: evidence for an evidence-based practice. Psychiatric Rehabilitation Journal 27, 345359.
Bond, G.R. & Drake, R.E. (2008). Predictors of competitive employment among patients with schizophrenia. Current Opinion in Psychiatry 21, 362369.
Burke-Miller, J.K., Cook, J.A., Grey, D.D., Razzano, L.A., Blyler, C.R., Leff, H.S., Gold, B.P., Goldberg, R.W., Mueser, K.T., Cook, W.L., Hoppe, S.K., Stewart, M., Blankertz, L., Dudek, K., Taylor, A.L. & Carey, M.A. (2006). Demographic characteristics and employment among people with severe mental illness in a Multi-site study. Community Mental Health Journal 42, 143159.
Burns, T., Catty, J., Becker, T., Drake, R.E., Fioritti, A., Knapp, M., Lauber, C., Rössler, W., Tomov, T., van Busschbach, J., White, S. & Wiersma, D. for the EQOLISE Group. (2007). The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial. Lancet 370, 11461152.
Burns, T., Catty, J., White, S., Becker, T., Koletsi, M., Fioritti, A., Rössler, W., Tomov, T., van Busschbach, J., Wiersma, D. & Lauber, C. for the EQOLISE Group (2009). The Impact of Supported Employment and Working on Clinical and Social Functioning: Results of an International Study of Individual Placement and Support. Schizophrenia Bulletin 35, 949958.
Butchemann, C.F. & Walwei, U. (1996). Employment security and dismissal protection. In International Handbook of Labour Market Policy and Evaluation (ed. Schmid, G., O'Reilly, J. and Schomann, K.). Edward Elgar: Cheltenham.
Cook, J.A. & Razzano, L. (2000). Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice. Schizophrenia Bulletin 26, 87103.
Department for Work and Pensions. (2004). Pathways to Work: Enabling Rehabilitation. Speech 12 October 2004. Secretary of State for Work and Pensions: London.
EuroStat (2006). European Business. Facts and Figures. Data 1995–2005. 2006 edition. Retrieved August 21, 2009, from http://epp.–001
First, M.B., Spitzer, R.L. & Williams, J.B.W. (1997). Structured Clinical Interview for the Diagnostic and Statistical Manual, Patient Version, 4th ed.American Psychiatric Press Washington, DC.
Harris, M.G., Henry, L.P., Harrigan, S.M., Purcell, R., Schwartz, O.S., Farrelly Prosser, A.L., Jackson, H.J. & McGorry, D. (2005). The relationship between duration of untreated psychosis and outcome: An eight-year prospective study. Schizophrenia Research 79, 8593.
Honey, A. (2004). Benefits and drawbacks of employment: Perspectives of people with mental illness. Qualitative Health Research 14, 381395.
Johnson, S., Kuhlmann, R. & the EPCAT Group (2000). The European service Mapping Schedule (ESMS): development of an instrument for the description and classification of mental health services. Acta Psychiatrica Scandinavica 102, Suppl. 405, 1423.
Kay, S.R., Opler, L.A. & Lindenmayer, J.P. (1987). The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13. 261276.
Kay, S.R., Opler, L.A. & Lindenmayer, J.P. (1989). The positive and negative syndrome scale (PANSS). Rationale and Standardization. British Journal of Psychiatry 155, 5965.
Kilian, R. & Becker, T. (2007). Macro-economic indicators and labour force participation of people with schizophrenia. Journal of Mental Health 16, 211222.
Knapp, M., Mangalore, R. & Simon, J. (2004). The Global costs of schizophrenia. Schizophrenia Bulletin 30, 279293.
Lehman, A.F. (1983). The effects of psychiatric symptoms on quality of life assessments among the chronically mentally ill. Evaluation and Program Planning 6, 143151.
Marwaha, S. & Johnson, S. (2004). Schizophrenia and employment: a review. Social Psychiatry and Psychiatric Epidemiology 39, 337349.
Marwaha, S., Johnson, S., Bebbington, P., Stafford, M., Angermeyer, M.C., Brugha, T., Azorin, J.-M., Kilian, R. & Hansen, K. (2007). Rates and correlates of employment in people with schizophrenia living in the UK, France and Germany. Findings from the EuroSc study. British Journal of Psychiatry 191, 3037.
Marwaha, S., Johnson, S., Bebbington, P., Azorin, J.-M., Brugha, T., Kilian, R., Toumi, M. & EuroSC Study Group (2008). Correlates of subjective quality of life in people with schizophrenia: findings from the EuroSC study. Journal of Nervous and Mental Disease 196, 8794.
McDaid, D. (2007). The economics of mental health in the workplace: what do we know and where do we go? Epidemiologia e Psichiatria Sociale 16, 294298.
McGurk, S.R. & Mueser, K.T. (2004). Cognitive functioning, symptoms and work in supported employment: a review and heuristic model. Schizophrenia Research 70, 147173.
Michon, H.W.C., Weegal van, J., Kroon, H., Schene, A.H. (2005). Person-related predictors of employment outcomes after participation in vocational rehabilitation programmes. Social Psychiatry and Psychiatric Epidemiology 40, 408416.
Office for National Statistics (2006). Regional Accounts. Regional Trends. Retrieved August 21, 2009, from http://www.statistics.
Organisation for Economic Co-operation and Development (2004). Employment Outlook. Retrieved August 21, 2009, from,2340,en_2649_201185_31935102_1_1_1_1,00.html
Pirkola, S.P., Isometsä, E.T., Heikkinen, M.E. & Lönnqvist, J.K. (2000). Suicides of Alcohol misusers and non-misusers in a nationwide population. Alcohol and Alcoholism 35, 7075.
Reid, Y., Johnson, S., Bebbington, P.E., Kuipers, E., Scott, H. & Thornicroft, G. (2001). The longer term outcomes of community care: a 12 year follow-up of the Camberwell High Contact Survey. Psychological Medicine 31, 351359.
Rogers, W.H. (1993) Regression standard errors in clustered samples. Stata Technical Bulletin 13, 1923.
Rosenheck, R., Leslie, D., Keefe, R., McEnvoy, J., Swartz, M., Perkins, D., Stroup, S., Hsiao, J., Lieberman, J. & CATIE Study Group Investigators (2006). Barriers to employment for people with schizophrenia. American Journal of Psychiatry 163, 411417.
Ruesch, P., Graf, J., Meyer, P.C., Rossler, W., Rossler, W. & Hell, D. (2004). Occupation, social support and quality of life of persons with schizophrenic or affective disorders. Social Psychiatry and Psychiatric Epidemiology 39, 386394.
Salkever, D.S., Slade, E.P. & Karakus, M.C. (2003). Employment retention by persons with schizophrenia employed in non-assisted jobs. Journal of Rehabilitation 69, 1926.
Salkever, D.S., Karakus, M.C., Slade, E.P., Harding, C.M., Hough, R.L., Rosenheck, R.A., Swartz, M.S., Barrio, C. & Yamada, A.M. (2007). Measures and predictors of community-based employment and earnings of persons with schizophrenia in a multi-site study. Psychiatric Services 58, 315324.
Sartorius, N. & Kuyken, W. (1994). Translation of health status instruments. In Quality of Life Assessment: International Perspectives (ed. Orley, J. and Kuyken, W.), pp 218. Springer: Berlin.
Secker, J., Grove, B. & Seebohm, P. (2001). Challenging barriers to employment, training and education for mental health service users: The service users perspective. Journal of Mental Health 10, 395404.
Watzke, S., Galvao, A., Gawlik, B., Huhne, M. & Brieger, P. (2006). Early termination of vocational rehabilitation for the severe mentally ill. Psychiatrische Praxis 33, 124131.
Weiden, P., Rapkin, B., Mott, T., Zygmunt, A., Goldman, D., Horvitz-Lennon, M. & Frances, A. (1994). Rating of Medication Influences (ROMI) Scale in schizophrenia. Schizophrenia Bulletin 20, 297310.
Wewiorski, N.J. & Fabian, E.S. (2004). Association between demographic and diagnostic factors and employment outcomes for people with psychiatric disabilities: a synthesis of recent research. Mental Health Services Research 6, 921.
Wing, J.K., Babor, T., Brugha, T., Burke, J., Cooper, J.E., Geil, R., Jablenski, A., Reiger, D. & Sartorius, N. (1990). SCAN: Schedules for Clinical assessment in Neuro Psychiatry. Archives of General Psychiatry 47, 589593.
Wong, K.K., Chiu, S.N., Chiu, L.P. & Tang, S. (2001). A supported competitive employment program for individuals with chronic mental illness. Hong Kong Journal of Psychiatry 11, 1318.
World Health Organization (1974). The International Pilot Study of Schizophrenia. WHO: Geneva.
World Health Organization (1992). SCAN: Schedules for Clinical Assessment in Neuropsychiatry. WHO: Geneva.



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