McGurk Susan R, Mueser Kim T
Department of Psychiatry, Mount Sinai School of Medicine, 1425 Madison Ave, Box 1230, New York, NY 10029-6574, USA.
Schizophr Res. 2004 Oct 1;70(2-3):147-73. doi: 10.1016/j.schres.2004.01.009.
Supported employment has been shown to improve the employment outcomes of clients with severe mental illness (SMI), but many clients who receive this service still fail to achieve their vocational goals. There is a need to better understand how illness-related impairments interfere with work, and how supported employment services deal with those impairments in order to improve the employment outcomes of clients with SMI.
We conducted a review of research on the relationship between cognitive functioning, symptoms, and competitive employment in clients with SMI. Based on this review, we developed a heuristic model of supported employment that proposes specific interactions between cognitive factors, symptoms, vocational services, and employment outcomes.
The review indicated that cognitive functioning and symptoms were strongly related to work in studies of general psychiatric samples. In studies of clients participating in vocational rehabilitation programs, associations between cognitive functioning, symptoms, and work were also present, but were attenuated, suggesting that vocational rehabilitation compensates for the effects of some cognitive impairments and symptoms on work. We describe a heuristic model of supported employment that posits specific and testable effects of cognitive domains and symptoms on vocational services and employment outcomes.
Supported employment appears to work by compensating for the effects of cognitive impairment and symptoms on work. The model may serve as a guide for research aimed at understanding how supported employment works, and for developing supplementary strategies designed to improve the effectiveness and cost-effectiveness of supported employment services.
已证明支持性就业可改善重度精神疾病（SMI）患者的就业成果，但许多接受此项服务的患者仍未能实现其职业目标。有必要更好地了解与疾病相关的障碍如何干扰工作，以及支持性就业服务如何应对这些障碍，以改善SMI患者的就业成果。
我们对有关SMI患者认知功能、症状与竞争性就业之间关系的研究进行了综述。基于该综述，我们构建了一个支持性就业的启发式模型，该模型提出了认知因素、症状、职业服务和就业成果之间的特定相互作用。
综述表明，在一般精神科样本研究中，认知功能和症状与工作密切相关。在参与职业康复项目的患者研究中，认知功能、症状与工作之间也存在关联，但这种关联有所减弱，这表明职业康复可弥补某些认知障碍和症状对工作的影响。我们描述了一个支持性就业的启发式模型，该模型假定认知领域和症状对职业服务和就业成果具有特定且可测试的影响。
支持性就业似乎是通过弥补认知障碍和症状对工作的影响来发挥作用的。该模型可作为研究指南，旨在了解支持性就业的工作方式，并制定旨在提高支持性就业服务有效性和成本效益的补充策略。
