Geisel School of Medicine at Dartmouth, Boston, MA.
Westat, Inc., Rockville, MD.
Schizophr Bull. 2018 Jan 13;44(1):32-37. doi: 10.1093/schbul/sbx115.
Impaired cognitive functioning is a significant predictor of work dysfunction in schizophrenia. Less is known, however about relationships of cognition and work in people with less severe disorders with relatively normal cognitive functioning.
This secondary analysis evaluated cognitive predictors of work in Social Security Disability Insurance (SSDI) beneficiaries with a recent work history who were randomized to receive mental health services, supported employment, and freedom from work disincentives over a 2-year study period in the Mental Health Treatment Study. Of the 1045 participants randomized to the treatment package, 945 (90.4%) received a cognitive assessment at study entry. Competitive work activity was evaluated using a computer-assisted timeline follow-back calendar at baseline and quarterly for 24 months.
Mood disorders were the most common psychiatric diagnoses (64.9%), followed by schizophrenia or schizoaffective disorder (35.1%). Tobit regression analyses predicting the average number of hours worked per week, controlling for demographic characteristics, diagnosis, and work history indicated that the cognitive composite score (P < .01) and verbal learning subscale scores (P < .001) were associated with fewer hours of weekly work over the study period.
Cognitive functioning predicted work over 2 years in SSDI beneficiaries with mood or schizophrenia-spectrum disorders who were receiving supported employment and mental health interventions, despite a relative absence of cognitive impairment in the study participants. The findings suggest cognitive functioning contributes to competitive work outcomes in persons with psychiatric disorders who have relatively unimpaired cognitive abilities, even under optimal conditions of treatment and vocational support.
认知功能障碍是精神分裂症患者工作障碍的重要预测因素。然而，对于认知功能相对正常、病情较轻的患者，认知与工作之间的关系则知之甚少。
本二次分析评估了在过去有工作经历的社会安全保险（SSDI）受助人中，认知对工作的预测作用。这些受助人参加了一项为期 2 年的研究，随机分为心理健康服务组、支持性就业组和工作激励组。在 1045 名接受治疗方案的参与者中，有 945 名（90.4%）在研究开始时接受了认知评估。基线时和接下来的 24 个月中每季度使用计算机辅助时间线回溯日历评估竞争性工作活动。
心境障碍是最常见的精神诊断（64.9%），其次是精神分裂症或分裂情感障碍（35.1%）。使用 Tobit 回归分析，控制人口统计学特征、诊断和工作经历，预测每周工作的平均小时数，结果表明认知综合评分（P<.01）和言语学习分量表评分（P<.001）与研究期间每周工作小时数减少有关。
尽管研究参与者的认知功能相对正常，但认知功能仍可预测接受支持性就业和心理健康干预的 SSDI 受助人在 2 年内的工作情况，这些受助人患有心境或精神分裂症谱系障碍。研究结果表明，即使在最佳治疗和职业支持条件下，认知功能也会影响具有相对正常认知能力的精神障碍患者的竞争性工作结果。
