Cook Judith A, Lehman Anthony F, Drake Robert, McFarlane William R, Gold Paul B, Leff H Stephen, Blyler Crystal, Toprac Marcia G, Razzano Lisa A, Burke-Miller Jane K, Blankertz Laura, Shafer Michael, Pickett-Schenk Susan A, Grey Dennis D
UIC Department of Psychiatry, University of Illinois at Chicago, 104 South Michigan Ave., Suite 900, Chicago, IL 60603, USA.
Am J Psychiatry. 2005 Oct;162(10):1948-56. doi: 10.1176/appi.ajp.162.10.1948.
Although large-scale surveys indicate that patients with severe mental illness want to work, their unemployment rate is three to five times that of the general adult population. This multisite, randomized implementation effectiveness trial examined the impact of highly integrated psychiatric and vocational rehabilitation services on the likelihood of successful work outcomes.
At seven sites nationwide, 1,273 outpatients with severe mental illness were randomly assigned either to an experimental supported employment program or to a comparison/services-as-usual condition and followed for 24 months. Data collection involved monthly services tracking, semiannual in-person interviews, recording of all paid employment, and program ratings made by using a services-integration measure. The likelihood of competitive employment and working 40 or more hours per month was examined by using mixed-effects random regression analysis.
Subjects served by models that integrated psychiatric and vocational service delivery were more than twice as likely to be competitively employed and almost 1(1/2) times as likely to work at least 40 hours per month when the authors controlled for time, demographic, clinical, and work history confounds. In addition, higher cumulative amounts of vocational services were associated with better employment outcomes, whereas higher cumulative amounts of psychiatric services were associated with poorer outcomes.
Supported employment models with high levels of integration of psychiatric and vocational services were more effective than models with low levels of service integration.
尽管大规模调查表明，患有严重精神疾病的患者想要工作，但其失业率是普通成年人口的三到五倍。这项多地点随机实施效果试验研究了高度整合的精神科和职业康复服务对成功就业结果可能性的影响。
在全国七个地点，1273名患有严重精神疾病的门诊患者被随机分配到一个实验性支持就业项目或一个对照/常规服务组，并随访24个月。数据收集包括每月的服务跟踪、半年一次的面对面访谈、所有带薪工作的记录，以及使用服务整合指标进行的项目评级。通过混合效应随机回归分析来研究竞争性就业和每月工作40小时或更多小时的可能性。
当作者控制了时间、人口统计学、临床和工作史等混杂因素后，接受整合了精神科和职业服务的模式治疗的受试者获得竞争性就业的可能性是对照组的两倍多，每月工作至少40小时的可能性几乎是对照组的1.5倍。此外，职业服务的累积量越高，就业结果越好，而精神科服务的累积量越高，结果越差。
精神科和职业服务高度整合的支持就业模式比服务整合程度低的模式更有效。
