Glynn Shirley M, Marder Stephen R, Noordsy Douglas L, O'Keefe Christopher, Becker Deborah R, Drake Robert E, Sugar Catherine A
Dr. Glynn and Dr. Marder are with the U.S. Department of Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, and the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles (UCLA) (e-mail:
Psychiatr Serv. 2017 Mar 1;68(3):271-277. doi: 10.1176/appi.ps.201500171. Epub 2016 Nov 1.
Although supported employment increases job acquisition for people with serious mental illness, data on participants' job tenure have been variable. This study evaluated the effects of a standardized work skills training program (the Workplace Fundamentals Module [WPFM]) on job tenure and other work outcomes among individuals receiving individual placement and support (IPS). The effects of two atypical antipsychotic medications on side effects were also tested. The primary hypothesis tested was that participants in IPS plus WPFM would have increased job tenure compared with those enrolled in IPS only, and the secondary hypothesis was that different antipsychotic medications would yield unique side effects.
A 2×2 randomized controlled trial compared work outcomes, including job tenure, of participants receiving IPS with or without WPFM for up to two years after obtaining a job. Participants were also randomly assigned to olanzapine or risperidone. Measures of work outcomes, clinical status, and medication side effects were collected.
Among 107 participants, 63% obtained at least one job. WPFM did not increase job tenure (51.53 and 41.37 total weeks worked for IPS only and IPS plus WPFM, respectively) or affect other work outcomes. Participants on olanzapine experienced increased body mass index, whereas those on risperidone lost weight, but medications did not differentially affect clinical or job outcomes.
Clinic-based skills training did not improve work outcomes accruing from IPS. Risperidone, compared with olanzapine, may reduce body mass but has no differential effect on other work or clinical outcomes.
尽管支持性就业增加了患有严重精神疾病者的就业机会，但关于参与者工作任期的数据却不尽相同。本研究评估了标准化工作技能培训项目（工作场所基础模块[WPFM]）对接受个体安置与支持（IPS）者的工作任期及其他工作成果的影响。还测试了两种非典型抗精神病药物的副作用。所检验的主要假设是，与仅参加IPS的参与者相比，参加IPS加WPFM的参与者工作任期会增加，次要假设是不同的抗精神病药物会产生独特的副作用。
一项2×2随机对照试验比较了在获得工作后长达两年内接受或未接受WPFM的IPS参与者的工作成果，包括工作任期。参与者还被随机分配至奥氮平组或利培酮组。收集了工作成果、临床状况及药物副作用的测量数据。
在107名参与者中，63%至少获得了一份工作。WPFM并未增加工作任期（仅参加IPS组和参加IPS加WPFM组的总工作周数分别为51.53周和41.37周），也未影响其他工作成果。服用奥氮平的参与者体重指数增加，而服用利培酮的参与者体重减轻，但药物对临床或工作成果并无差异影响。
基于诊所的技能培训并未改善IPS带来的工作成果。与奥氮平相比，利培酮可能会降低体重，但对其他工作或临床成果并无差异影响。
