Department of Psychiatry and Stein Institute for Research on Aging, University of California, San Diego, 9500 Gilman Drive 0851, La Jolla, CA 92093, USA.
Schizophr Res. 2012 Mar;135(1-3):100-4. doi: 10.1016/j.schres.2011.11.036. Epub 2011 Dec 22.
Supported employment is the evidence-based treatment of choice for assisting individuals with severe mental illness to achieve competitive employment, but few supported employment programs specifically target older clients with psychiatric illness. The purpose of this study was to evaluate the efficacy of supported employment for middle-aged or older people with schizophrenia.
Participants included 58 outpatients with schizophrenia or schizoaffective disorder aged 45 or older who were recruited from a community mental health clinic. Participants were randomly assigned to receive Individual Placement and Support (IPS; the manualized version of supported employment) or conventional vocational rehabilitation (CVR) for one year, and completed assessments at baseline, six months, and twelve months.
IPS was superior to CVR on nearly all work outcome measures, including attainment of competitive employment, weeks worked, and wages earned. Fifty-seven percent of IPS participants worked competitively, compared with 29% of CVR participants; 70% of IPS participants obtained any paid work, compared with 36% of CVR participants. Within the IPS group, better baseline functional capacity (as measured by the UCSD Performance Based Skills Assessment) and more recent employment were modestly associated with better work outcomes.
Middle-aged and older adults with schizophrenia are good candidates for supported employment services.
支持性就业是帮助患有严重精神疾病的个体获得竞争性就业的循证治疗选择，但很少有专门针对有精神疾病的中老年客户的支持性就业计划。本研究旨在评估支持性就业对中年或老年精神分裂症患者的疗效。
参与者包括从社区心理健康诊所招募的 58 名年龄在 45 岁或以上的精神分裂症或分裂情感障碍门诊患者。参与者被随机分配接受个体化安置和支持（IPS；支持性就业的规范化版本）或常规职业康复（CVR）治疗一年，并在基线、六个月和十二个月进行评估。
IPS 在几乎所有工作结果测量上均优于 CVR，包括获得竞争性就业、工作周数和工资收入。IPS 组的 57%参与者获得竞争性就业，而 CVR 组为 29%；IPS 组的 70%参与者获得任何有薪工作，而 CVR 组为 36%。在 IPS 组中，基线时更好的功能能力（由 UCSD 基于表现的技能评估衡量）和最近的就业情况与更好的工作结果有一定的相关性。
中年和老年精神分裂症患者是支持性就业服务的良好候选者。
