While research has demonstrated strong relationships between negative symptoms and social difficulties in schizophrenia, little is known about the possible role of employment status and setting in this relationship. Seventy-seven participants with a diagnosis of schizophrenia spectrum disorder, who were either unemployed (n = 34), employed within a specialty mental health setting (n = 23), or employed within a community setting (n = 20) were assessed twice, six weeks apart, as to their negative symptoms and social functioning. Work in community settings generally predicted an increase in the levels of social functioning over time. However, individuals with high levels of negative symptoms who were employed in community settings evinced substantial decline in social functioning over time compared to unemployment or to employment in specialty mental health settings. These results are consistent with action models of psychopathology and encourage heightened sensitivity to individual symptomatic profiles in the course of vocational rehabilitation.

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The manifestation, course, and prognosis of schizophrenia are extremely variable, raising an interest in the role of personality and self-concept in the illness' outcome. Building on voluminous research attesting to the fragility and instability of the self in schizophrenia, we examined the role of four self-concept aspects--self-esteem level, self-esteem instability, self-concept clarity, and the perception of the self as ill--in schizophrenia-spectrum disorders. Eighty-nine outpatients were assessed at baseline, and five days subsequently, regarding these self-concept aspects, symptoms, stress, and quality of life. Six weeks later, participants were again assessed using the baseline battery. Self-esteem instability predicted a decrease in quality of life over the study period. Self-concept clarity predicted an increase in quality of life and in positive symptoms, particularly under low stress. Depressive symptoms predicted a decrease in self-esteem levels and an increase in the perception of the self as ill. Thus, all four self-concept aspects were shown to be pertinent to the experience of schizophrenia, albeit in different ways. Special attention should be directed to self-concept clarity, which embeds both risk and resilience.

Drawing from the field of cognitive vulnerability to depression, we hypothesized that in persistent psychosis, perception of the self as ill interacts with illness-related stress to predict depressive symptoms. Fifty-five patients with dual diagnosis (i.e., psychosis and substance abuse disorder) participating in a community-based intervention were assessed as to their depressive symptoms, perception of the self as ill, and illness-related stress focusing on stigmatization and exposure to community violence. As expected, illness-related stress predicted depressive symptoms under high, but not low, levels of the experience of the self as ill. These effects were obtained when both hopelessness depression symptoms and "regular" depressive symptoms were examined. Findings encourage further application of the field of cognitive vulnerability to depression in psychosis research and treatment.

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