Association of functional employment outcomes with symptomatic remission and frailty factors in chronic patients with schizophrenia - cohort study

Abstract

Background: Clinically the intervention progresses for the patients with schizophrenia validated through the response to treatment remission and recovery From the perspective of occupational rehabilitation occupational therapists focus on holistic function of persons’ life from self-care to work The recovery stage is thus emphasized on their regaining function after symptom control In addition the patients with productive life have a very important meaning in their occupational roles Functional employment contributes substantially to the quality and satisfaction of life is very important to patients with mental disorders Moreover employment status is considered a crucial milestone of improved functioning for patients with schizophrenia The optimal goal for the patients is to return to the community with regular employment Researchers showed that the factors about sustainable employability were complicated and influenced by many confounding variables Robust evidences about return to work for the disable people indicated the factors including age gender education background completion of training program future target job and occupational status before intervention In schizophrenia patients symptomatic remission in psychopathology and other variables such as age at onset type and dose of antipsychotics psychosocial function performance initial employment type and social support as well as skill were considered in employment outcomes in this study In addition employment outcomes were reported to be negative associated with physical frailty which is found to be prevalent in the elder population The employment sustainability in schizophrenia patients was also related to physical competency especially if their jobs require considerable physical effort Therefore the association about physical frailty and prolonged employment outcome is worthy to be monitored in a longitudinal follow-up study Therefore this dissertation adopted a longitudinal cohort study that aimed to examine the association about employment outcomes with the symptomatic remission and physical frailty in schizophrenia after controlling for potential confounding variables Aim The present dissertation includes two studies with the following aims: Study 1 explores the association between symptomatic remission in schizophrenia and their employment outcomes in a two-year longitudinal study; Study 2 is a longitudinal four-year study that investigates the association between physical frailty and employment outcomes in schizophrenia Methods In Study 1 all of 525 stable patients with schizophrenia in the therapeutic community of a public mental hospital in Taiwan were recruited between 2013 and 2015 Employment outcomes defined as the cumulative on-the-job duration (months/per year) and income (new Taiwan dollars NT$/per year) were investigated at the end of 1- and 2-year follow-up periods after enrollment For repeated measurements linear mixed models were constructed to examine the association between symptomatic remission and employment outcomes after controlling for potential confounding variables including age sex education type and daily dose of antipsychotics cognitive function personal and social performance scale (PSP) and initial employment type Study 2 All 561 stable patients with schizophrenia in a therapeutic community in Taiwan were recruited Employment outcomes defined as the cumulative annual work duration (months/per year) and income (NT$/per year) were investigated repeatedly at the end of 1- 2- 3- and 4-year follow-ups after enrollment Generalized estimating equation models were constructed to determine the association between physical frailty (shrink、weakness、exhaustion、slowed walking speed、low activity) and employment outcomes after controlling for variables including age sex education antipsychotic medication and daily dose cognitive function instrumental activities of daily living (IADL) medical comorbidity and initial employment state at the beginning year Results The findings of Study 1 showed the average age of the patients was 51 8 years and 65 3% were males Among them 124 patients (23 6% 124/525) met the remission criteria at baseline The outcomes in remission group at first full year were 7 21 months/per year and 11 378 NT$/per year; the outcomes in nonremission group at first full year were 3 71 months/per year and 3 048 NT$/per year The linear mixed-model analysis showed that patients who had symptomatic remission were employed 0 8 of a month longer (p = 0 029) and earned NT$3 250 more (p = 0 006) within 1 year than those who did not show symptomatic remission In addition the cumulative on-the-job duration was associated with personal and social performance scale (PSP) (? = 0 03 p = 0 043) In Study 2: The average age of the patients was 53 78 years and 64 7% were men Among them 57 patients (10 2%) met the physical frailty criteria at the baseline The outcomes in frailty group at first full year were 1 54 months/per year and 626 4 NT$/per year; the outcomes in nonfrailty group at first full year were 5 81 months/per year and 6 055 NT$/per year After controlling for confounding variables we found that patients with physical frailty were employed 1 01 month less (p = 0 004) and earned NT$518 less (p = 0 029) per year than those without physical frailty In addition the patient with slow walking speed was found to be negatively associated with work duration (? = -0 82 p = 0 029) Instrumental activities of daily living (IADL) was found to be positively associated with both the cumulative work duration and income in the two models (? = 0 08; 85 3 p

Date of Award	2020
Original language	English
Supervisor	Jer-Hao Chang (Supervisor)