支持严重精神疾病患者就业：国际证据的系统评价和荟萃分析。
Supported employment for people with severe mental illness: systematic review and meta-analysis of the international evidence.
机构信息
Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia.
Matthew Modini, BPsych, Leona Tan, MPsych, School of Psychiatry, University of New South Wales, Sydney, Australia; Beate Brinchmann, MA PsyD, Nordland Hospital Trust, Bodø, and University of Tromsø - Arctic University of Norway, Tromsø, Norway; Min-Jung Wang, MSc, School of Psychiatry, University of New South Wales, Sydney; Eoin Killackey, DPsych, Centre for Youth Mental Health, University of Melbourne, and Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Australia; Nicholas Glozier, PhD, Brain and Mind Centre, Central Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia; Arnstein Mykletun, PhD, Norwegian Institute of Public Health, Bergen and Oslo, and The Arctic University of Norway, Department of Community Medicine, Tromsø, in collaboration with Nordland Hospital Trust, Bodø, Norway; Samuel B. Harvey, PhD, School of Psychiatry, University of New South Wales, Black Dog Institute, Sydney, and St George Hospital, Kogarah, Australia
出版信息
Br J Psychiatry. 2016 Jul;209(1):14-22. doi: 10.1192/bjp.bp.115.165092. Epub 2016 Apr 21.
BACKGROUND
Individual placement and support (IPS) is a vocational rehabilitation programme that was developed in the USA to improve employment outcomes for people with severe mental illness. Its ability to be generalised to other countries and its effectiveness in varying economic conditions remains to be ascertained.
AIMS
To investigate whether IPS is effective across international settings and in different economic conditions.
METHOD
A systematic review and meta-analysis of randomised controlled trials comparing IPS with traditional vocational services was undertaken; 17 studies, as well as 2 follow-up studies, were included. Meta-regressions were carried out to examine whether IPS effectiveness varied according to geographic location, unemployment rates or gross domestic product (GDP) growth.
RESULTS
The overall pooled risk ratio for competitive employment using IPS compared with traditional vocational rehabilitation was 2.40 (95% CI 1.99-2.90). Meta-regressions indicated that neither geographic area nor unemployment rates affected the overall effectiveness of IPS. Even when a country's GDP growth was less than 2% IPS was significantly more effective than traditional vocational training, and its benefits remained evident over 2 years.
CONCLUSIONS
Individual placement and support is an effective intervention across a variety of settings and economic conditions and is more than twice as likely to lead to competitive employment when compared with traditional vocational rehabilitation.
背景
个体安置与支持（IPS）是一种职业康复计划，最初在美国开发，旨在改善严重精神疾病患者的就业结果。其在其他国家推广的能力及其在不同经济条件下的有效性仍有待确定。
目的
调查 IPS 在国际环境和不同经济条件下是否有效。
方法
对随机对照试验进行了系统评价和荟萃分析，比较 IPS 与传统职业服务；纳入了 17 项研究以及 2 项随访研究。进行了荟萃回归分析，以检查 IPS 的有效性是否根据地理位置、失业率或国内生产总值（GDP）增长而有所不同。
结果
使用 IPS 与传统职业康复相比，竞争就业的总体汇总风险比为 2.40（95%CI 1.99-2.90）。荟萃回归分析表明，地理位置和失业率均不会影响 IPS 的总体效果。即使一个国家的 GDP 增长率低于 2%，IPS 也明显比传统职业培训更有效，并且其益处在 2 年内仍然明显。
结论
个体安置与支持是一种在各种环境和经济条件下都有效的干预措施，与传统职业康复相比，其导致竞争就业的可能性高出两倍以上。
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