What is it about?
Supported Employment (SE) programs help people with serious mental illness find and keep jobs. Associated cognitive impairments can be a barrier to employment. In this study 175 participants with schizophrenia or schizoaffective disorder received supported employment or supported employment plus cognitive remediation and were classified into higher or lower community functioning according to a median split of their quality-of-life scores at baseline. Participants received one year of active intervention and follow-up a year later. Results: Employment rates over two years for participants with lower community functioning were significantly different for the two conditions (supported employment=20%, plus cognitive remediation=49%, p<.005), whereas participants with higher functioning showed equivalent rates of employment (62% versus 54%, ns). Among lower-functioning participants, those who received cognitive remediation also worked significantly more hours over two years than those who received supported employment only, but higher-functioning participants worked similar amounts of hours in both conditions. Improvements in cognitive functioning and intrinsic motivation were related to employment outcomes but only for the lower functioning group in the supported employment plus cognitive remediation condition, suggesting possible mechanisms for the observed effects.
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Why is it important?
Augmenting supported employment with cognitive remediation may boost vocational outcomes for participants with lower community functioning but may not be necessary for those functioning better in their communities.
Perspectives
Sustained employment is an important part of recovery from serious mental illness. While supported employment provides appropriate opportunity and guidance, cognitive impairments can be a barrier to success. Cognitive training can address those deficits with good employment results. However, cognitive training may only be needed for those who have report poor community functioning. Focusing resources on those who need it most is an important goal in providing personalized and effective mental health care.
Morris Bell
Yale University
Read the Original
This page is a summary of: Benefits of Cognitive Remediation and Supported Employment for Schizophrenia Patients With Poor Community Functioning, Psychiatric Services, April 2014, American Psychiatric Association,
DOI: 10.1176/appi.ps.201200505.
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