Zito Wayne, Greig Tamasine C, Wexler Bruce E, Bell Morris D
Yale University School of Medicine, Department of Psychiatry, 34 Park St., New Haven, CT 06519, United States.
Schizophr Res. 2007 Aug;94(1-3):81-8. doi: 10.1016/j.schres.2007.03.026. Epub 2007 May 23.
This study examined predictors of intensity of vocational specialist support for clients with schizophrenia or schizoaffective disorder in supported employment. Sixty-nine outpatients with schizophrenia or schizoaffective disorder were recruited from a community mental health center for 12 months of vocational and cognitive rehabilitation. Neuropsychological test scores, symptom ratings, illness severity, and employment history were used to predict vocational support intensity, expressed as hours coached in ratio to total hours worked over 12 months for each client. Weekly work hours were inversely correlated with intensity of vocational support. Half of the sample averaged 10 to 40 h of work per week and received significantly lower proportions of on-site job coaching than the lowest quartile, which averaged 2 to 5 h of work per week. Regressions predicting support intensity from neuropsychological composite scores, educational/vocational, and hospitalization history were not significant. Significant regressions included PANSS, SANS, and SAPS subscales, after which individual symptoms responsible for explained variance were isolated. SANS social inattention and PANSS active avoidance together predicted 23% of the variance in support intensity. A one-way ANOVA comparing work participation quartiles on these symptoms revealed significantly higher levels of active avoidance and social inattention for participants working less than 10 h per week. A profile emerged of the high intensity client as a socially inattentive or avoidant individual requiring a limited work schedule. Results suggest that these clients require more specialist contact because of failure to adequately engage natural supports at work.
本研究调查了在支持性就业中，职业专家为精神分裂症或分裂情感性障碍患者提供支持的强度的预测因素。从一个社区心理健康中心招募了69名患有精神分裂症或分裂情感性障碍的门诊患者，进行为期12个月的职业和认知康复治疗。使用神经心理学测试分数、症状评级、疾病严重程度和就业史来预测职业支持强度，职业支持强度以每位患者在12个月内接受指导的小时数与总工作小时数的比率来表示。每周工作小时数与职业支持强度呈负相关。样本中有一半人平均每周工作10至40小时，他们接受的现场工作指导比例明显低于最低四分位数，后者平均每周工作2至5小时。从神经心理学综合分数、教育/职业和住院史预测支持强度的回归分析并不显著。显著的回归分析包括阳性和阴性症状量表（PANSS）、阴性症状评定量表（SANS）和阳性症状评定量表（SAPS）的分量表，之后分离出导致可解释方差的个体症状。SANS中的社交注意力不集中和PANSS中的主动回避共同预测了支持强度方差的23%。一项对这些症状进行工作参与四分位数比较的单因素方差分析显示，每周工作少于10小时的参与者的主动回避和社交注意力不集中水平明显更高。由此形成了高强度患者的形象，即一个社交注意力不集中或回避社交、需要有限工作时间表的个体。结果表明，这些患者需要更多的专家接触，因为他们在工作中未能充分利用自然支持。
