Stig Evensen

Prevalence, Employment Rate, and Cost of Schizophrenia in a High-Income Welfare Society: A Population-Based Study Using Comprehensive Health and Welfare Registers

Schizophrenia is associated with recurrent hospitalizations, need for long-term community support, poor social functioning, and low employment rates. Despite the wide- ranging financial and social burdens associated with the illness, there is great uncertainty regarding prevalence, employment rates, and the societal costs of schizophrenia. The current study investigates 12-month prevalence of patients treated for schizophrenia, employment rates, and cost of schizophrenia using a population-based top-down approach. Data were obtained from comprehensive and mandatory health and welfare registers in Norway. We identified a 12-month prevalence of 0.17% for the entire population. The employment rate among working-age individuals was 10.24%. The societal costs for the 12-month period were USD 890 million. The average cost per individual with schizophrenia was USD 106 thousand. Inpatient care and lost productivity due to high unemployment represented 33% and 29%, respectively, of the total costs. The use of mandatory health and welfare registers enabled a unique and informative analysis on true population-based datasets.

The MATRICS Consensus Cognitive Battery (MCCB): Performance and functional correlates

Neurocognitive impairment is a core feature in psychotic disorders and the MATRICS Consensus Cognitive Battery (MCCB) is now widely used to assess neurocognition in this group. The MATRICS has been translated into several languages, including Norwegian; although this version has yet to be investigated in an adult clinical population. Further, the relationship between the MATRICS and different measures of functioning needs examination. The purpose of this study was to describe neurocognition assessed with the Norwegian version of the MATRICS battery in a sample of patients with psychotic disorders compared to age and gender matched healthy controls and to examine the association with educational-, occupational- and social-functioning in the patient group. One hundred and thirty one patients and 137 healthy controls completed the battery. The Norwegian version of the MATRICS was sensitive to the magnitude of neurocognitive impairments in patients with psychotic disorders, with patients displaying significant impairments on all domains relative to healthy controls. Neurocognition was also related to both self-rated and objective functional measures such as social functioning, educational- and employment-history.

Employment outcome and predictors of competitive employment at 2-year follow-up of a vocational rehabilitation programme for individuals with schizophrenia in a high-income welfare society

Abstract Background: Employment is an important part of recovery for individuals with schizophrenia. The employment rate for this group is as low as 10% in Norway, and major system related barriers to employment are evident. Aims: This study reports the competitive employment outcome at 2-year follow-up of a vocational rehabilitation study augmented with cognitive remediation (CR) or elements from cognitive behaviour therapy (CBT) for individuals with schizophrenia spectrum disorders. It also investigates if global functioning, self-esteem, and depression at baseline predicts employment outcome, and if change in these variables during the intervention period is associated with employment outcome. Method: One hundred and forty-eight participants with schizophrenia spectrum disorders in six Norwegian counties received 10 months vocational rehabilitation augmented with either CBT (n = 84) or CR (n = 64). Both competitive and sheltered workplaces were used. Participants were assessed at baseline, at the end of the intervention period, and at 2-year follow-up. Results: At 2-year follow-up, 21.2% had obtained competitive employment. A further 25.3% had work placements in competitive workplaces. Significant improvements were found in global functioning, self-esteem, and depression during the intervention period, but no significant differences between the two intervention groups. High baseline global functioning and self-esteem, as well as positive change in these variables during the intervention period, were significantly associated with higher competitive employment outcome at 2-year follow-up. Conclusion: The results add to existing evidence that competitive employment is attainable for individuals with schizophrenia. High global functioning and self-esteem were strongly associated with competitive employment outcome.

Vocational rehabilitation for adults with psychotic disorders in a Scandinavian welfare society

BackgroundThis study examined the outcomes of a vocational rehabilitation program (The Job Management Program, JUMP) for persons with psychotic disorders based on close collaboration between health and welfare services.MethodsParticipants (N = 148) with broad schizophrenia spectrum disorders (age 18–65) were recruited from six counties in Norway. Three counties were randomized to vocational rehabilitation augmented with cognitive behaviour therapy (CBT), while the remaining three counties were randomized to vocational rehabilitation augmented with cognitive remediation (CR). This paper compares the vocational activity of the total group of JUMP participants with a treatment as usual group (N = 341), and further examines differences between the two JUMP interventions. Employment status (working/not working) was registered at the time of inclusion and at the end of the intervention period.ResultsThe total number of JUMP participants in any kind of vocational activity increased from 17 to 77% during the intervention. Of these, 8% had competitive employment, 36% had work placements in ordinary workplaces with social security benefits as their income, and 33% had sheltered work. The total number of working participants in the TAU group increased from 15.5 to 18.2%. The JUMP group showed significant improvements of positive (t = −2.33, p = 0.02) and general (t = −2.75, p = 0.007) symptoms of psychosis. Significant differences between the CBT and CR interventions were not demonstrated.ConclusionsThe study supports existing evidence that the majority of persons with broad schizophrenia spectrum disorders can cope with some kind of work, given that internal and external barriers are reduced. Those who wish to work should be offered vocational rehabilitation.Trial registrationClinicalTrials.gov Identifier: NCT01139502. Registered on 6 February 2010.

Vocational Functioning in Schizophrenia Spectrum Disorders: Does Apathy Matter?

Abstract While the influence of negative symptoms on vocational outcome is well documented, the specific contribution of apathy is less explored. The current study examined the influence of apathy on vocational outcome. A total of 148 participants were included in a vocational rehabilitation study, offering cognitive remediation (CR) or cognitive behavior therapy (CBT) to address work-related issues. Clinical and functional measures were assessed on inclusion and at posttreatment after approximately 10 months. The level of apathy was not related to the acquisition of work, but higher levels of apathy predicted fewer hours worked per week during the study. Previous employment predicted future employment, and higher education predicted more hours worked and higher score on the Work Behavior Inventory. The results did not differ across interventions. Thus, despite apathy, people with schizophrenia were able to work when the barriers to employment were addressed and adequate support was given.

Validation of the Work Behavior Inventory

Abstract Background: The Work Behavior Inventory (WBI) was developed in the USA for the assessment of vocational functioning for people with severe mental illness. It is rated in a work setting by an employment specialist through observation and an interview with the immediate supervisor. Aims: The present study aims to examine the psychometric properties of the Norwegian version of the WBI. Methods: The participants (n = 148) of the Job Management Program (JUMP) study for psychotic disorders were assessed with the WBI around the fourth week of work. A principal component analysis identified three substantial factors. Results: The three corresponding scales were termed Social Skills revised, Work Quality revised and Compliance with work norms. The scales had a high internal consistency. Correlations with the Social Functioning Scale, education and previous work history supported the validity of the subscales. Conclusion: The results indicate that the Norwegian version of the WBI maintains good psychometric properties, and that vocational functioning can be reliably and validly assessed in a Norwegian setting. Clinical implications: There has been a lack of validated assessment tools for this group in Norway. Functional assessment with the WBI provides a comprehensive evaluation of the individuals’ strengths and challenges in the vocational setting, and provides goals for the vocational rehabilitation.

Cognitive remediation and occupational outcome in schizophrenia spectrum disorders: A 2 year follow-up study

Neurocognitive impairment is prominent in schizophrenia and a significant predictor of poor occupational outcomes. Vocational rehabilitation (VR) is frequently implemented to counteract high unemployment rates. Individuals with schizophrenia however face numerous challenges such as neurocognitive impairments and psychotic symptoms. Hence, augmenting VR to address illness-related factors may optimize occupational outcomes. The aim of this study was to examine the effects of Cognitive Remediation (CR) combined with VR(CR+VR) compared to techniques from Cognitive Behavioral Therapy (CBT) combined with VR(CBT+VR) on neurocognition and occupational functioning over a 2year period. A total of 131participants underwent assessment with the MATRICS Consensus Cognitive Battery (MCCB) at baseline, post treatment (after 10months) and follow-up (2years after randomization). Occupational status and number of hours worked were recorded at all assessment points. Both groups improved on several neurocognitive domains. All improvements were however in favor of the CR group. There was a significant increase in number of participants working and hours worked in both groups throughout the project period, with no between-group differences. Number of hours worked at follow-up was predicted by change in Working Memory and the Composite Score in the CR group. CR-augmented VR improved several domains, particularly Verbal Learning and Working Memory, which were central in the CR program. The combination of VR and CR or CBT thus enabled a significant proportion of participants to attain and maintain work.