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Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

  • Sherry Kit Wa Chan (a1), Herbert H. Pang (a2), Kang K. Yan (a3), Christy Lai Ming Hui (a4), Yi Nam Suen (a5), Wing Chung Chang (a6), Edwin Ho Ming Lee (a7), Pak Sham (a8) and Eric Yu Hai Chen (a9)...

Abstract

Background

Little is known about long-term employment outcomes for patients with first-episode schizophrenia-spectrum (FES) disorders who received early intervention services.

Aims

We compared the 10-year employment trajectory of patients with FES who received early intervention services with those who received standard care. Factors differentiating the employment trajectories were explored.

Method

Patients with FES (N = 145) who received early intervention services in Hong Kong between 1 July 2001 and 30 June 2002 were matched with those who entered standard care 1 year previously. We used hierarchical clustering analysis to explore the 10-year employment clusters for both groups. We used the mixed model test to compare cluster memberships and piecewise regression analysis to compare the employment trajectories of the two groups.

Results

There were significantly more patients who received the early intervention service in the good employment cluster (early intervention: N = 98 [67.6%]; standard care: N = 76 [52.4%]; P = 0.009). In the poor employment cluster, there was a significant difference in the longitudinal pattern between early intervention and standard care for years 1–5 (P < 0.0001). The number of relapses during the first 3 years, months of full-time employment during the first year and years of education were significant in differentiating the clusters of the early intervention group.

Conclusions

Results suggest there was an overall long-term benefit of early intervention services on employment. However, the benefit was not sustained for all patients. Personalisation of the duration of the early intervention service with a focus on relapse prevention and early vocational reintegration should be considered for service enhancement.

Declaration of interests

No relevant conflicts of interests reported by C.L.M.H., Y.N.S., P.S., H.H.P. and K.K.Y. S.K.W.C., W.C.C. and E.H.M.L. report that they are members of the working group of the Early Assessment Service for Young People with Psychosis (EASY) programme of the Hospital Authority in Hong Kong. E.Y.H.C. is the convener of the working group of the EASY programme of the Hospital Authority in Hong Kong.

Copyright

Corresponding author

Correspondence: Sherry Kit Wa Chan, Room 219, New Clinical Building, Department of Psychiatry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong. Email: kwsherry@hku.hk

References

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1Lehman, AF, Goldberg, R, Dixon, LB, McNary, S, Postrado, L, Hackman, A, et al. Improving employment outcomes for persons with severe mental illnesses. Arch Gen Psychiatry 2002; 59: 165–72.
2Luciano, A, Bond, GR, Drake, RE. Does employment alter the course and outcome of schizophrenia and other severe mental illnesses? A systematic review of longitudinal research. Schizophr Res 2014; 159: 312–21.
3Marwaha, S, Johnson, S, Bebbington, P, Stafford, M, Angermeyer, MC, Brugha, T, et al. Rates and correlates of employment in people with schizophrenia in the UK, France and Germany. Br J Psychiatry 2007; 191: 30–7.
4Mueser, KT, Salyers, MP, Mueser, PR. A prospective analysis of work in schizophrenia. Schizophr Bull 2001; 27: 281–96.
5Birchwood, M, Todd, P, Jackson, C. Early intervention in psychosis. The critical period hypothesis. Br J Psychiatry Suppl 1998; 172: 53–9.
6Bertolote, J, McGorry, P. Early intervention and recovery for young people with early psychosis: consensus statement. Br J Psychiatry Suppl 2005; 48: s1169.
7Correll, CU, Galling, B, Pawar, A, Krivko, A, Bonetto, C, Ruggeri, M, et al. Comparison of early intervention services vs treatment as usual for early-phase psychosis: a systematic review, meta-analysis, and meta-regression. JAMA Psychiatry 2018; 75: 555–65.
8Bertelsen, M, Jeppesen, P, Petersen, L, Thorup, A, Øhlenschlaeger, J, le Quach, P, et al. Five-year follow-up of a randomized multicenter trial of intensive early intervention vs standard treatment for patients with a first episode of psychotic illness: the OPUS trial. Arch Gen Psychiatry 2008; 65: 762–71.
9Secher, RG, Hjorthøj, CR, Austin, SF, Thorup, A, Jeppesen, P, Mors, O, et al. Ten-year follow-up of the OPUS specialized early intervention trial for patients with a first episode of psychosis. Schizophr Bull 2015; 41: 617–26.
10Norman, RMG, Manchanda, R, Malla, AK, Windell, D, Harricharan, R, Northcott, S. Symptom and functional outcomes for a 5 year early intervention program for psychoses. Schizophr Res 2011; 129: 111–5.
11Chan, SKW, Chan, SWY, Pang, HH, Yan, KK, Hui, CLM, Chang, WC, et al. Association of an early intervention service for psychosis with suicide rate among patients with first-episode schizophrenia-spectrum disorders. JAMA Psychiatry 2018; 75: 458–64.
12Chan, SKW, So, HC, Hui, CLM, Chang, WC, Lee, EHM, Chung, DWS, et al. 10-year outcome study of an early intervention program for psychosis compared with standard care service. Psychol Med 2015; 45: 1181–93.
13Singh, SP. Early intervention in psychosis. Br J Psychiatry 2010; 196: 343–5.
14Albert, N, Melau, M, Jensen, H, Emborg, C, Jepsen, JRM, Fagerlund, B, et al. Five years of specialised early intervention versus two years of specialised early intervention followed by three years of standard treatment for patients with a first episode psychosis: randomised, superiority, parallel group trial in Denmark (OPUS II). BMJ 2017; 356: i6681.
15Malla, A, Joober, R, Iyer, S, Norman, R, Schmitz, N, Brown, T, et al. Comparing three-year extension of early intervention service to regular care following two years of early intervention service in first-episode psychosis: a randomized single blind clinical trial. World Psychiatry 2017; 16: 278–86.
16Chang, WC, Chan, GHK, Jim, OTT, Lau, ESK, Hui, CLM, Chan, SKW, et al. Optimal duration of an early intervention programme for first-episode psychosis: randomised controlled trial. Br J Psychiatry 2015; 206: 492500.
17Velthorst, E, Fett, A-KJ, Reichenberg, A, Perlman, G, van Os, J, Bromet, EJ, et al. The 20-year longitudinal trajectories of social functioning in individuals with psychotic disorders. Am J Psychiatry 2017; 174: 1075–85.
18Marwaha, S, Johnson, S. Schizophrenia and employment - a review. Soc Psychiatry Psychiatr Epidemiol 2004; 39: 337–49.
19Carpenter, WT Jr, Strauss, JS. The prediction of outcome in schizophrenia. IV: eleven-year follow-up of the Washington IPSS cohort. J Nerv Ment Dis 1991; 179: 517–25.
20Racenstein, JM, Harrow, M, Reed, R, Martin, E, Herbener, E, Penn, DL. The relationship between positive symptoms and instrumental work functioning in schizophrenia: a 10 year follow-up study. Schizophr Res 2002; 56: 95103.
21Tang, JYM, Wong, GHY, Hui, CLM, Lam, MML, Chiu, CPY, Chan, SKW, et al. Early intervention for psychosis in Hong Kong–the EASY programme. Early Interv Psychiatry 2010; 4: 214–9.
22Chan, SKW, Hui, CLM, Chang, WC, Lee, EHM, Chen, EYH. Ten-year follow up of patients with first-episode schizophrenia spectrum disorder from an early intervention service: predictors of clinical remission and functional recovery. Schizophr Res 2019; 204: 6571.
23Haro, JM, Kamath, SA, Ochoa, S, Novick, D, Rele, K, Fargas, A, et al. The Clinical Global Impression–Schizophrenia scale: a simple instrument to measure the diversity of symptoms present in schizophrenia. Acta Psychiatr Scand 2003; 107: 1623.
24Haro, JM, Novick, D, Bertsch, J, Karagianis, J, Dossenbach, M, Jones, PB. Cross-national clinical and functional remission rates: Worldwide Schizophrenia Outpatient Health Outcomes (W-SOHO) study. Br J Psychiatry 2011; 199: 194201.
25Nosè, M, Tansella, M, Thornicroft, G, Schene, A, Becker, T, Veronese, A, et al. Is the Defined Daily Dose system a reliable tool for standardizing antipsychotic dosages? Int Clin Psychopharmacol 2008; 23: 287–90.
26Kay, SR, Fiszbein, A, Opler, LA. The positive and negative syndrome scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76.
27Morosini, PL, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R. Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatr Scand 2000; 101: 323–9.
28Goodman, SH, Sewell, DR, Cooley, EL, Leavitt, N. Assessing levels of adaptive functioning: the Role Functioning Scale. Community Ment Health J 1993; 29: 119–31.
29Kaufman, L, Rousseeuw, PJ. Finding Groups in Data. John Wiley & Sons, 1990.
30Yao, XI, Wang, X, Speicher, PJ, Hwang, ES, Cheng, P, Harpole, DH, et al. Reporting and guidelines in propensity score analysis: a systematic review of cancer and cancer surgical studies. J Natl Cancer Inst 2017; 109: djw323.
31Bond, GR, Drake, RE, Luciano, A. Employment and educational outcomes in early intervention programmes for early psychosis: a systematic review. Epidemiol Psychiatr Sci 2015; 24: 446–57.
32Hui, CLM, Honer, WG, Lee, EHM, Chang, WC, Chan, SKW, Chen, ESM, et al. Long-term effects of discontinuation from antipsychotic maintenance following first-episode schizophrenia and related disorders: a 10 year follow-up of a randomised, double-blind trial. Lancet Psychiatry 2018; 5: 432–42.

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Ten-year employment patterns of patients with first-episode schizophrenia-spectrum disorders: comparison of early intervention and standard care services

  • Sherry Kit Wa Chan (a1), Herbert H. Pang (a2), Kang K. Yan (a3), Christy Lai Ming Hui (a4), Yi Nam Suen (a5), Wing Chung Chang (a6), Edwin Ho Ming Lee (a7), Pak Sham (a8) and Eric Yu Hai Chen (a9)...
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