Geoffrey Waghorn

Demographic and clinical correlates of comorbid substance use disorders in psychosis: multivariate analyses from an epidemiological sample ☆

BACKGROUND While there has been substantial research examining the correlates of comorbid substance abuse in psychotic disorders, it has been difficult to tease apart the relative importance of individual variables. Multivariate analyses are required, in which the relative contributions of risk factors to specific forms of substance misuse are examined, while taking into account the effects of other important correlates. METHODS This study used multivariate correlates of several forms of comorbid substance misuse in a large epidemiological sample of 852 Australians with DSM-III-R-diagnosed psychoses. RESULTS Multiple substance use was common and equally prevalent in nonaffective and affective psychoses. The most consistent correlate across the substance use disorders was male sex. Younger age groups were more likely to report the use of illegal drugs, while alcohol misuse was not associated with age. Side effects secondary to medication were associated with the misuse of cannabis and multiple substances, but not alcohol. Lower educational attainment was associated with cannabis misuse but not other forms of substance abuse. CONCLUSION The profile of substance misuse in psychosis shows clinical and demographic gradients that can inform treatment and preventive research.

‘Earning and learning’ in those with psychotic disorders: The second Australian national survey of psychosis:

Objective: Participation in mainstream education and employment facilitates both the recovery and the social inclusion of people with psychotic disorders. As part of the second Australian survey of psychosis, we assessed labour force activity and participation in formal education among working age adults with psychotic disorders. Method: Data were drawn from a large national community prevalence survey of adults with psychotic disorders. Known as the Survey of High Impact Psychosis (SHIP), it was conducted in seven Australian catchment areas during March to December 2010. Current and past year labour force activity, current employment, past year participation in formal education and vocational training, and key clinical and demographic characteristics were examined in a sample of 1825 participants. Results: Only 22.4% of people with psychotic disorders were found to be employed (either full-time or part-time) in the month prior to the survey. In the previous 12 months, 32.7% were employed at some time. Of those in competitive employment, the majority worked part-time (63.9%), while a quarter worked 38 or more hours per week (23.4%). In terms of educational attainment, 18.4% reported difficulties with reading or writing, while 31.9% completed high school, which represents 12 years of formal education. Conclusions: The proportion currently employed has remained stable at 22% since the last national survey in 1997. Policy makers and service providers could do more to ensure people with psychotic disorders obtain access to more effective forms of assistance with respect to both their continuing education and employment. More effective vocational and educational interventions for people with psychotic disorders appear to be urgently needed.

Delineating disability, labour force participation and employment restrictions among persons with psychosis

Objective:  To delineate at a population level: activity restrictions, labour market participation, educational attainment, employment restrictions and employment characteristics of persons with psychosis compared with healthy non‐disabled persons.

The Challenge of Integrating Employment Services with Public Mental Health Services in Australia: Progress at the First Demonstration Site

OBJECTIVE Integrating vocational services into public mental health services is a key component of evidence-based supported employment for people with severe mental illness. While this approach has been developed in the USA, it has only recently been attempted internationally and in Australia. This report summarizes the early implementation challenges at the first Australian demonstration site. METHOD ORYGEN Youth Health (OYH) in Melbourne established an evidence-based supported employment research project in December 2005. Challenges to service integration and fidelity were documented descriptively in order to inform other international sites attempting to implement similar evidence-based practices. RESULTS Experiences at this demonstration site identify the major barriers to integration and suggest how these can be overcome. CONCLUSION Successful integration of employment with youth mental health services is feasible in Australia within six months.

Implementing Evidence-Based Employment Services in New Zealand for Young Adults with Psychosis: Progress during the First Five Years

This practice evaluation demonstrates how occupational therapists can play a key role in providing vocational services for young people experiencing a first episode of psychosis. By implementing the evidence-based Individual Placement and Support model, occupational therapists can expand their traditional roles to provide services that integrate functional recovery with clinical recovery. This New Zealand programme achieved vocational outcomes of between 49% and 59% over a 4-year period. The lessons learned from these experiences add to the body of international knowledge on how best to implement evidence-based employment services for young people with mental health problems.

Classifying Socially-Valued Role Functioning Among Community Residents with Psychiatric Disorders

An increased emphasis on community-based care has not ensured that people recovering from psychiatric disorders return to active and valued roles in their local communities. Although clinical recovery remains a priority for mental health services there is increasing recognition of the need for functional recovery to be attained and demonstrated in roles valued by the wider community. With this need in mind, a method for classifying socially-valued role functioning among people with schizophrenia or schizoaffective disorder was developed and trialed. Participants (n = 104) were recruited via mental health, psychosocial rehabilitation, and other community support services. Socially-valued roles were investigated via participation in five categories: (1) self-care and home duties; (2) caring for others; (3) self-development, voluntary work or rehabilitation; (4) formal education or training; and (5) employment. Activities were classified by primary role type and role status level at baseline, six, and 12 months. Current role status was assessed along with highest and lowest status in the previous year. Preliminary psychometric results were favorable. Research applications are now recommended for monitoring socially-valued role functioning in community settings.

Labour force activity by people with depression and anxiety disorders : a population-level second-order analysis

Objective:  To identify the population‐level first‐ and second‐order effects among candidate correlates of labour force activity by people with ICD‐10 depression and anxiety disorders.

Work-related subjective experiences, work-related self-efficacy, and career learning among people with psychiatric disabilities

Work-related subjective experiences and work-related self-efficacy were investigated as candidate correlates of career learning among people with schizophrenia and schizoaffective disorder. Work-related self-efficacy was expected to mediate any observed relationship between work-related subjective experiences and employment status, after controlling for demographic, vocational, and clinical covariates. Baseline measures (n 1 = 104) were repeated at six months (n 2 = 94) and 12 months (n 3 = 94). Work-related subjective experiences and work-related self-efficacy were consistently associated with current employment after controlling for covariates. The proposed mediator role of work-related self-efficacy remains a viable hypothesis requiring further investigation. Both work-related subjective experiences and work-related self-efficacy appear promising as components of the social cognitive career learning theory to help explain career development among people with psychiatric disabilities.

Work performance among Australians with depression and anxiety disorders: a population level second order analysis.

At a population level, little is known about how anxiety and depression impact on work performance. We investigated the first and second order correlates of work accomplishment and care taken at work among people with International Statistical Classification of Diseases and Related Health Problems, 10th Revision, affective and anxiety disorders in comparison to healthy community residents. Australian Bureau of Statistics multistage sampling strategies obtained a household sample of 37,580 working age individuals. A secondary analysis was conducted using multiple binary logistic regression. The first order correlates of work performance were the extent of employment restrictions, mental health status, age, sex, and whether or not treatment was received. At the second order level, the effects of mental health status on work performance depended on age, sex, and receiving treatment. The effect of employment restrictions on work performance depended on age and sex only.

A multi‐site randomised controlled trial of evidence‐based supported employment for adults with severe and persistent mental illness

BACKGROUND/AIM The Individual Placement and Support (IPS) approach is an evidence-based form of supported employment for people with severe and persistent mental illness. This approach is not yet widely available in Australia even though there is mounting evidence of its generalisability outside the USA. One previous Australian randomised controlled trial found that IPS is effective for young people with first episode psychosis. The aim of the current trial was to assess the effectiveness of evidence-based supported employment when implemented for Australian adult consumers of public mental health services by utilising existing service systems. METHODS A four-site randomised control trial design (n = 208) was conducted in Brisbane (two sites), Townsville and Cairns. The intervention consisted of an IPS supported employment service hosted by a community mental health team. The control condition was delivered at each site by mental health teams referring consumers to other disability employment services in the local area. RESULTS At 12 months, those in the IPS condition had 2.4 times greater odds of commencing employment than those in the control condition (42.5% vs. 23.5%). The conditions did not differ on secondary employment outcomes including job duration, hours worked, or job diversity. Attrition was higher than expected in both conditions with 28.4% completing the baseline interview but taking no further part in the study. CONCLUSION The results support previous international findings that IPS-supported employment is more effective than non-integrated supported employment. IPS can be successfully implemented this way in Australia, but with a loss of effect strength compared to previous USA trials.