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Articles   |    
Quality of Life and Competitive Work Among Adults With Severe Mental Illness: Moderating Effects of Family Contact
Paul B. Gold, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.201200553
View Author and Article Information

Dr. Gold is with the Department of Counseling, Higher Education, and Special Education, University of Maryland, 3214 Benjamin Building, College Park, MD 20742 (e-mail: pbgold08@gmail.com).

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Competitive employment may improve life quality for adults with severe mental illness, but it is not known for whom or under what circumstances. On the basis of previous research demonstrating benefits of family contact for African-American adults with severe mental illness, it was hypothesized that frequent family contact would moderate (enhance) a positive association between competitive employment and global quality of life for a rural sample of predominantly African-American adults.

Methods  In a secondary analysis of data collected from a randomized trial of supported employment, a series of nested random regression analyses was conducted to test the hypothesized moderating effect of face-to-face family contact on the association between competitive employment and global quality of life, controlling for severity of psychiatric symptoms and satisfaction with family relations.

Results  Most of the 143 study participants spent time with a family member at least once a month (80%)—and most at least weekly (60%). Participants who held a competitive job and had face-to-face contact with family members at least weekly reported higher global quality of life than all other study participants.

Conclusions  In this rural sample of African-American adults with severe mental illness, competitive work was associated with higher global quality of life only for those who frequently spent time with family members. Research is needed to test the generalizability of this finding to other geographic settings and cultures, as well as the feasibility and effectiveness of formal inclusion of family members in psychosocial rehabilitation interventions.

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Table 1Baseline demographic and clinical characteristics of 143 participants, by competitive work status
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a Participants who worked at least one week in a competitive job over 24 months

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b Participants who worked less than one week in a competitive job over 24 months

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c Proportions were compared with chi square tests (df=1), and means were compared by F tests (df=1 and 141).

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d Positive and Negative Syndrome Scale total score. Possible scores range from 30 to 210, with higher scores indicating greater severity of symptoms.

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e Data were missing for five participants with any competitive work and for one participant with no competitive work.

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f SSI, Supplemental Security Income; SSDI, Social Security Disability Insurance. Data were missing for one participant with any competitive work and for three participants with no competitive work.

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Table 2Measures at baseline and four time points for 143 participants, by competitive work status
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a Participants who worked at least one week in a competitive job over 24 months

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b Participants who worked less than one week in a competitive job over 24 months

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c Number of observations available at each time point

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d Measured by the sum of two items from Lehman’s Quality of Life Interview (QOLI). Possible scores range from 7 to 14, with higher scores indicating more satisfaction.

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e Positive and Negative Syndrome Scale total score. Possible scores range from 30 to 210, with higher scores indicating greater severity of symptoms.

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f Measured by the mean of two items from the QOLI. Possible scores range from 1 to 7, with higher scores indicating more satisfaction.

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g Measured by one item from the QOLI: “In the past month, how often did you get together with a member of your family?” Possible scores range from 1 to 5, with higher scores indicating more frequent contact.

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Table 3Random regression analyses estimating the effects of family contact and competitive work group status on global quality of life for 143 participantsa
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a The analysis controlled for psychiatric symptoms and family relations over 24 months. Model 1 (unconditional means) not shown; intraclass coefficient=.65; deviance (–2LL [minus twice log-likelihood difference])=2,781; Bayesian information criterion (BIC)=2,976

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b Model 2: deviance=2,774; BIC=2,804

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c Model 3: PANSS, Positive and Negative Syndrome Scale. Deviance=2,736; BIC=2,770

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d Model 4: deviance=2,701; BIC=2,740

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e Model 5: deviance=2,701; BIC=2,745

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f Model 6: deviance=2,697; BIC=2,747

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g Model 7: deviance=2,693; BIC=2,747

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h Denoted as 5 time points of measurement (baseline and 6, 12, 18, and 24 months)

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i The error covariance structure of all models was specified with a block-diagonal unstructured variance-covariance matrix; all models were fitted using restricted maximum likelihood estimation.

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Table 4Unadjusted global quality of life scores over 24 months, by face-to-face contact with family and competitive work statusa
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a Global quality of life was measured with the sum of two items from Lehman’s Quality of Life Interview (QOLI). Possible scores range from 7 to 14, with higher scores indicating more satisfaction. Face-to-face family contact was measured with one item from the QOLI: “In the past month, how often did you get together with a member of your family?” Possible scores range from 1 to 5, with higher scores indicating more frequent contact.

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b More than once per week (scale score ≥4)

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c Less than once per week (scale score ≤3)

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d Worked at least one week in a competitive job over 24 months

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e Worked less than one week in a competitive job over 24 months

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f Number of respondents at each time point

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