Interventions for obtaining and maintaining employment in adults with severe mental illness, a network meta-analysis

Abstract

Supported employment and augmented supported employment were the most effective interventions for people with severe mental illness in terms of obtaining and maintaining employment, based on both the direct comparison analysis and the network meta-analysis, without increasing the risk of adverse events. These results are based on moderate- to low-quality evidence, meaning that future studies with lower risk of bias could change these results. Augmented supported employment may be slightly more effective compared to supported employment alone. However, this difference was small, based on the direct comparison analysis, and further decreased with the network meta-analysis meaning that this difference should be interpreted cautiously. More studies on maintaining competitive employment are needed to get a better understanding of whether the costs and efforts are worthwhile in the long term for both the individual and society.

Effectiveness of augmented Individual Placement and Support interventions for competitive employment in people with schizophrenia: Systematic review and meta-analysis

“…Nevertheless, it is reasonable to consider that early interventions will mean greater long-term benefits and that, given the clinical and sociodemographic characteristics of this age group, the treatment goal should include outcomes that are not only job-related, but also academic. Previous meta-analysis (Carmona et al, 2017;Kinoshita et al, 2013;Modini et al, 2016;Suijkerbuijk et al, 2017) have consistently reported the positive effect of standard IPS interventions in work outcomes. However, very few of them have evaluated the effect of augmented IPS interventions, given that the heterogeneity of the interventions makes it difficult to compare.…”

“…Accordingly, augmented versions have been developed in which IPS is complemented by other psychosocial interventions (Gold et al, 2006;McGurk, Mueser, & Pascaris, 2005;Mueser et al, 2005;Wallace & Tauber, 2004). Systematic reviews and recent meta-analysis on supported employment in people with SMI (Carmona, Gomez-Benito, Huedo-Medina, & Rojo, 2017;Kinoshita et al, 2013;Modini et al, 2016;Suijkerbuijk et al, 2017) do not evaluate the effectiveness of augmented IPS interventions or stratify their results by diagnosis. This is important due to the functional limitations entailed by schizophrenia (Harvey et al, 2012), as well as the accompanying stigma compared with other SMI, which leads to lower employment rates.…”

“Placement Budgets” for Supported Employment—Impact on Quality of Life in a Multicenter Randomized Controlled Trial

“…Links were also found between job tenure and non-vocational outcomes, such as improved self-esteem, social integration, and relationships. With respect to competitive employment, the benefit of IPS compared to traditional vocational rehabilitation was confirmed in two recent meta-analyses (13, 17). Here we want to expand this literature by focusing on associations between competitive employment and QoL.…”

“…All these elements are incorporated in the concept of quality of life (QoL) in persons with mental disorders (11, 12). Currently, the most promising vocational rehabilitation model is supported employment (SE) (1, 13). The “Individual Placement and Support model” (IPS), as conceptualized by Becker and Drake (14), is a cornerstone of SE and helps persons with serious and persistent mental disorders to find competitive employment according to their choices as soon as possible and receive all support needed to maintain their position.…”

The effectiveness of vocational rehabilitation on work participation: a propensity score matched analysis using nationwide register data

“…Several recent reviews have focused on interventions aiming to promote work participation among individuals with ill-health (1)(2)(3)(4)(5)(6)(7)(8). Among the various interventions, vocational rehabilitation services have been associated with favorable outcomes (5,(9)(10)(11)(12)(13)(14)(15)(16). There is nevertheless much methodological and programme-related diversity between the studies.…”