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Articles   |    
Correlates of Competitive Versus Noncompetitive Employment Among Adults With Psychotic Disorders
Geoffrey Waghorn, Ph.D.; Sukankta Saha, Ph.D.; John J. McGrath, M.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300096
View Author and Article Information

The authors are with the Queensland Centre for Mental Health Research and the School of Medicine, University of Queensland, Brisbane, Queensland, Australia (e-mail: geoff_waghorn@qcmhr.uq.edu.au).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Studies of the demographic and clinical correlates of employment activity have proven useful for identifying employment assistance needs among people with severe and persistent mental illness. However, the results of prior studies remain unclear, and most reviews of prior studies have not differentiated competitive from noncompetitive employment. This study attempted to clarify the relative strength and consistency of correlates of competitive versus noncompetitive employment.

Methods  Data were drawn from a population-based survey of Australian adults with psychotic disorders between March and December 2010. Demographic, clinical, and employment assistance correlates of competitive and noncompetitive employment were compared. The sample comprised 1,825 participants who agreed to face-to-face interviews.

Results  A total of 408 (22.3%) participants were employed in the previous four weeks, 330 (18.1%) in competitive employment and 78 (4.3%) in noncompetitive employment. Those in competitive employment were more likely to be female and aged 18–34, to have a partner, to have received formal vocational training or education after high school, and to have no literacy difficulties. Better global functioning, shorter illness duration, less severe course of illness, and affective versus nonaffective psychosis were associated with a greater likelihood of competitive employment. Those using Australian government employment services were less likely to be in competitive employment, suggesting a service provider preference for noncompetitive employment.

Conclusions  Four times as many employees were in competitive employment than in noncompetitive employment. The negative relationship between employment assistance and competitive employment highlights the urgent need to improve the effectiveness of Australian employment services for people with severe mental illnesses.

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Table 1Demographic correlates of competitive versus noncompetitive employment among 408 adults with psychotic disordersa
Table Footer Note

a Employment was defined as being employed in the past four weeks.

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b Model 2 was adjusted for age, sex, immigrant status, partnered status, education, global functioning, course of illness, and receipt of support for employment. Global functioning and course of illness were correlated (Kendall tau b=–.25, p<.001), but the estimates were within acceptable limits.

Table Footer Note

c To increase power, some age groups were combined (18–24 and 25–34 years and 45–54 and 55–64 years).

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d To increase power, the age-of-onset quartiles (later age [28–62 years] and middle age [22–27 years] and early age [18–21 years] and very early age [5–17 years]) were combined into the two categories shown.

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Table 2Clinical correlates of competitive versus noncompetitive employment among 408 adults with psychotic disordersa
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a Employment was defined as being employed in the past four weeks.

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b Adjusted for age, sex, immigrant status, partnered status, education, global functioning, course of illness, and receipt of support for employment. Global functioning and course of illness were correlated (Kendall tau b=–.25, p<.001); however, the estimates were within acceptable limits.

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c Includes schizoaffective, bipolar, and depressive disorders and mania

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d Includes schizophrenia and delusional and nonorganic psychoses

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e NOS, not otherwise specified; includes severe depression without psychosis and a positive screen for psychosis without meeting ICD–10 criteria for psychosis

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f Estimates were not available because of low sample size.

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Table 3Job acquisition method and receipt of employment support among 408 adults with psychotic disorders, by type of employmenta
Table Footer Note

a Employment was defined as being employed in the past four weeks.

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b Adjusted for age, sex, immigrant status, partnered status, education, global functioning, course of illness, and receipt of support for employment. Global functioning and course of illness were correlated (Kendall tau b=–.25, p<.001); however, the estimates were within acceptable limits.

Table Footer Note

c Support, advice, or counseling from an employment support worker in the last 12 months

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