Supported employment among veterans with serious mental illness: the role of cognition and social cognition on work outcome.

Unemployment is a primary functional deficit for the majority of adults with schizophrenia. Research indicates that over two-thirds of adults living in the community with schizophrenia are unemployed. Despite effective programs to assist with job identification and placement, the ability to attain and maintain employment remains a pressing concern. Neurocognitive functioning is widely acknowledged to be a determinant of work outcome; however, effect sizes tend to be in the small to medium range. The present study sought to further understand the determinants of work outcome among a sample of 104 veterans with schizophrenia enrolled in a supported employment program. A small percentage of veterans in the study got competitive jobs; 53% who secured jobs maintained employment for longer than 6 months. Cognition, social cognition, and symptoms were unrelated to job attainment. However, speed of processing and social cognition were significant predictors of work outcomes such as wages and tenure. These findings suggest that cognitive abilities including processing speed and the ability to accurately interpret and respond to social cues are significant determinants of whether individuals with schizophrenia remain employed. The results are discussed in light of current available treatment options and domains to target in synergy with work rehabilitation efforts.