Karpov B, Joffe G, Aaltonen K, Suvisaari J, Baryshnikov I, Näätänen P, Koivisto M, Melartin T, Oksanen J, Suominen K, Heikkinen M, Isometsä E
Department of Psychiatry, University of Helsinki and Helsinki University Hospital, P.O. Box 22 (Välskärinkatu 12 A), 00014 Helsinki, Finland.
National Institute for Health and Welfare, Department of Mental Health and Substance Abuse Services, Mannerheimintie 166, 00271 Helsinki, Finland.
Eur Psychiatry. 2017 Jul;44:83-89. doi: 10.1016/j.eurpsy.2017.03.010. Epub 2017 Apr 7.
Major mental disorders are highly disabling conditions that result in substantial socioeconomic burden. Subjective and objective measures of functioning or ability to work, their concordance, or risk factors for them may differ between disorders.
Self-reported level of functioning, perceived work ability, and current work status were evaluated among psychiatric care patients with schizophrenia or schizoaffective disorder (SSA, n=113), bipolar disorder (BD, n=99), or depressive disorder (DD, n=188) within the Helsinki University Psychiatric Consortium Study. Correlates of functional impairment, subjective work disability, and occupational status were investigated using regression analysis.
DD patients reported the highest and SSA patients the lowest perceived functional impairment. Depressive symptoms in all diagnostic groups and anxiety in SSA and BD groups were significantly associated with disability. Only 5.3% of SSA patients versus 29.3% or 33.0% of BD or DD patients, respectively, were currently working. About half of all patients reported subjective work disability. Objective work status and perceived disability correlated strongly among BD and DD patients, but not among SSA patients. Work status was associated with number of hospitalizations, and perceived work disability with current depressive symptoms.
Psychiatric care patients commonly end up outside the labour force. However, while among patients with mood disorders objective and subjective indicators of ability to work are largely concordant, among those with schizophrenia or schizoaffective disorder they are commonly contradictory. Among all groups, perceived functional impairment and work disability are coloured by current depressive symptoms, but objective work status reflects illness course, particularly preceding psychiatric hospitalizations.
重度精神障碍是导致严重社会经济负担的高度致残性疾病。不同精神障碍在功能或工作能力的主观和客观测量、二者的一致性或相关危险因素方面可能存在差异。
在赫尔辛基大学精神病学联盟研究中，对患有精神分裂症或分裂情感性障碍（SSA，n = 113）、双相情感障碍（BD，n = 99）或抑郁症（DD，n = 188）的精神科护理患者的自我报告功能水平、感知工作能力和当前工作状态进行了评估。使用回归分析研究功能损害、主观工作残疾和职业状态的相关因素。
DD患者报告的感知功能损害最高，SSA患者最低。所有诊断组中的抑郁症状以及SSA和BD组中的焦虑与残疾显著相关。目前，只有5.3%的SSA患者在工作，而BD或DD患者的这一比例分别为29.3%或33.0%。约一半的患者报告有主观工作残疾。BD和DD患者的客观工作状态与感知残疾之间有很强的相关性，但SSA患者并非如此。工作状态与住院次数相关，感知工作残疾与当前抑郁症状相关。
精神科护理患者通常最终脱离劳动力市场。然而，虽然在心境障碍患者中，工作能力的客观和主观指标在很大程度上是一致的，但在精神分裂症或分裂情感性障碍患者中，它们通常是相互矛盾的。在所有组中，感知功能损害和工作残疾都受到当前抑郁症状的影响，但客观工作状态反映了疾病进程，尤其是精神病住院之前的情况。
