Sakai Kazuya, Hashimoto Takeshi, Inuo Sadafumi
Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Hyogo, Japan.
Work. 2009;32(2):227-33. doi: 10.3233/WOR-2009-0809.
As the mental health care system in Japan is putting an increased emphasis on community rehabilitation, an effective working-support program is needed for patients with schizophrenia. In order to examine personal factors associated with competitive employment, a retrospective, cross-sectional study was conducted with patients involved in an integrated program that provides both psychiatric care and a working-support service for patients with schizophrenia. Thirty six schizophrenic outpatients who were employed in the working support program participated. Patients were divided into a working group and a non-working group, depending on whether they worked more or less than 20 hours a week. The working group significantly differed from the non-working group in that they were more likely to have completed high school (p<0.05, Fisher's exact probability test), disclosed their disability to their employers (p<0.05, Fisher's exact probability test) and worked less than 20 hours in their initial employment (p<0.001, Fisher's exact probability test). Logistic regression analysis revealed that the disclosure of disabilities (odds ratio=6.00, p=0.02), shorter initial working-time (odds ratio=27.6, p<0.001), or higher educational level (odds ratio=6.42, p=0.02) increased the probability of success of competitive employment. For the other outcomes (severity of psychotic symptoms, disability of daily life or subjective QOL), there was no difference between the two groups (p>0.05, respectively, Mann-Whitney's U-test). In this program, participation in competitive employment may not be associated with the severity of psychotic symptoms, disability of daily life or subjective QOL but may be promoted by the disclosure of disabilities, shorter initial working-time and higher education.
由于日本的精神卫生保健系统越来越重视社区康复，因此需要为精神分裂症患者制定有效的工作支持计划。为了研究与竞争性就业相关的个人因素，对参与一项综合计划的患者进行了一项回顾性横断面研究，该计划为精神分裂症患者提供精神护理和工作支持服务。36名参加工作支持计划并受雇的精神分裂症门诊患者参与了研究。根据患者每周工作时间是否超过20小时，将患者分为工作组和非工作组。工作组与非工作组存在显著差异，具体表现为工作组更有可能完成高中学业（p<0.05，Fisher精确概率检验）、向雇主披露自己的残疾情况（p<0.05，Fisher精确概率检验）以及在初次就业时工作时间少于20小时（p<0.001，Fisher精确概率检验）。逻辑回归分析显示，披露残疾情况（优势比=6.00，p=0.02）、较短的初次工作时间（优势比=27.6，p<0.001）或较高的教育水平（优势比=6.42，p=0.02）会增加竞争性就业成功的概率。对于其他结果（精神病症状的严重程度、日常生活能力或主观生活质量），两组之间没有差异（分别为p>0.05，Mann-Whitney U检验）。在该计划中，参与竞争性就业可能与精神病症状的严重程度、日常生活能力或主观生活质量无关，但可能会因披露残疾情况、较短的初次工作时间和较高的教育水平而得到促进。
