Employment in Personality Disorders and the Effectiveness of Individual Placement and Support: Outcomes from a Secondary Data Analysis

Abstract

Purpose Personality disorders (PDs) are associated with severe functional impairment and subsequent high societal costs, increasing the need to improve occupational functioning in PD. Individual placement and support (IPS) is an effective, evidence-based method of supported employment, which so far has been tested in various mixed patient populations with severe mental illness (SMI, including PDs). However, the effectiveness of IPS for PDs per se remains uninvestigated. Methods Data from the SCION trial were used, including 31 SMI patients with PDs and 115 SMI patients with other primary diagnoses (primarily psychotic disorders). First, the interaction effect of diagnosis (PD vs other SMI) and intervention (IPS vs traditional vocational rehabilitation) was studied. Second, in the IPS condition, difference between diagnostic groups in time to first job was studied. Results We did not find evidence of a moderating effect of PD diagnosis on the primary effect of IPS (proportion who started in regular employment) (OR = 0.592, 95% CI 0.80-4.350, p = 0.606) after 30 months. Also, PD diagnosis did not moderate the effect of time until first job in IPS. Conclusions From the present explorative analysis we did not find evidence for a moderating effect of PD diagnosis on the effectiveness of IPS among PD participants. This indicates that IPS could be as effective in gaining employment in participants with PD as it is in participants with other SMI. Future studies, implementing larger numbers, should confirm whether IPS is equally effective in PDs and study whether augmentations or alterations to the standard IPS model might be beneficiary for PD.

The societal cost of treatment-seeking patients with borderline personality disorder in Germany

“…While traditionally, in Germany, the first step in vocational rehabilitation is to treat and then engage people on the sheltered labor market, only a small percentage of patients can thus finally be integrated into the general labor market [49]. In contrast, supported employment programs such as individual placement and support (IPS) follow the strategy "place-and-treat-/ train" instead of "train/treat-then-place" concurrently offering care and at the same time helping in finding employment [50,51]. Thereby, specific barriers to employment, such as distance to the labor market and stigma, are dealt with.…”

Individual Health Budgets in Mental Health: Results of Its Implementation in the Friuli Venezia Giulia Region, Italy

“…Further, economic insecurity is common among patients with severe mental disorders [ 43 , 44 ], as well as functional impairment, which prevents them from living an independent life [ 45 ]. Despite this evidence, working interventions, which can highly enhance functional impairment [ 46 ], have not been widely used in the IHB group. The most of IHBs were indeed focused on the living axis [ 47 ], which comprehended a variety of “housing opportunities”, such as therapeutic–rehabilitative dwellings, individual and grouped flats, and personalized support at home.…”

“…Nonetheless, the diverse association between these clinical diagnoses and IHB is not easy to explain. Both disorders, in fact, are associated with functional impairment, unemployment, and interpersonal deficits [ 45 , 46 ]. Fifthly, we did not include pharmacological assessment, which could have affected HoNOS ratings.…”

Long-Term Effects of the Individual Placement and Support Intervention on Employment Status: 6-Year Follow-Up of a Randomized Controlled Trial

“…Type of the mental issue is also critical as it seems to be more effective in some disorders and less and in others (21,84). A systematic review of studies assessing IPS efficacy in individuals with substance use disorders found that episodic treatment of the disease and risk of relapse of the mental disease were among important barriers in implementing IPS (22).…”