Hoffmann Holger, Kupper Zeno, Zbinden Marius, Hirsbrunner Hans-Peter
Bern University Hospital of Social and Community Psychiatry, Laupenstrasse 49, P. O. Box 52, 3000 Bern 10, Switzerland.
Soc Psychiatry Psychiatr Epidemiol. 2003 Feb;38(2):76-82. doi: 10.1007/s00127-003-0603-x.
Vocational rehabilitation is a central issue in the rehabilitation of patients with chronic schizophrenia. However, even with the help of comprehensive integration programs, achieving this objective remains a very ambitious and difficult undertaking. Therefore, a profound and up-to-date knowledge of vocational functioning and outcome predictors in patients who have the goal to return into competitive employment is imperative. The objective of the present study was to test the predictors summarized in the recent review of Cook and Razzano, as well as to test those predictors specified in the nine hypotheses put forward by Anthony and Jansen in schizophrenia patients enrolled in a vocational rehabilitation program.
The predictive value of ten hypotheses centering on vocational functioning and outcome were consecutively tested in a sample of 53 schizophrenia patients. Those predictors identified as significant were then taken into a 'winner take all' regression in order to determine which of them were the best.
The overall work performance observed in a workshop proved to be the best predictor of vocational functioning. Contrary to the pivotal claim in Anthony and Jansen's review, in our sample, negative symptoms indeed influenced vocational functioning, outcome and functional skills. Cognitive impairments, social competence and fatalistic control beliefs also had predictive value for vocational functioning and outcome.
These results reflect the accumulated findings of the past decade as summarized by Cook and Razzano. Moreover, they serve to substantiate the necessity of promoting the concept of cognitive remediation and associated programs designed to transform fatalistic beliefs into feelings of hopefulness, thereby enhancing the readiness of schizophrenia patients to enroll in rehabilitation programs.
职业康复是慢性精神分裂症患者康复中的核心问题。然而，即便借助全面的综合项目，实现这一目标仍是一项极具挑战性且艰巨的任务。因此，对于立志重返竞争性就业岗位的患者，深入了解其职业功能及结果预测因素至关重要。本研究旨在检验Cook和Razzano近期综述中总结的预测因素，以及Anthony和Jansen针对参加职业康复项目的精神分裂症患者提出的九个假设中所明确的预测因素。
对53名精神分裂症患者样本依次检验了围绕职业功能和结果的十个假设的预测价值。随后将被确定为显著的预测因素纳入“胜者通吃”回归分析，以确定其中哪些是最佳预测因素。
在工作坊中观察到的总体工作表现被证明是职业功能的最佳预测因素。与Anthony和Jansen综述中的关键观点相反，在我们的样本中，阴性症状确实影响职业功能、结果和功能技能。认知障碍、社交能力和宿命论控制信念对职业功能和结果也具有预测价值。
这些结果反映了Cook和Razzano总结的过去十年的累积研究结果。此外，它们证实了推广认知康复概念及相关项目的必要性，这些项目旨在将宿命论信念转变为希望感，从而增强精神分裂症患者参与康复项目的意愿。
