The National University of Singapore, School of Public Health, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
The University of Maryland, Baltimore County (UMBC), Baltimore, USA.
Adm Policy Ment Health. 2019 Jul;46(4):474-487. doi: 10.1007/s10488-019-00926-1.
Employment is an important goal for persons who have a severe mental illness (SMI). The current literature finds some evidence for a positive relationship between employment and measures of mental health (MH) status, however study design issues have prevented a causal interpretation. This study aims to measure the causal effect of employment on MH status and total MH costs for persons with SMI. In a quasi-experimental prospective design, self-reported data measured at baseline, 6-months, and 12-months, on MH status and employment are paired with Public Mental Health System (PMHS) claims data. The study population (N = 5162) is composed of persons with a SMI who received PMHS services for a year or more. Outcome variables are MH status symptom scores from the BASIS-24 instrument and total MH costs. The estimation method is full information maximum likelihood, which allows for tests of employment endogeneity. Outcomes with an insignificant test of endogeneity are estimated using tobit or ordinary least square (OLS). Employment has modest but meaningful effects on MH status (including overall MH status, functioning, and relationships) and reduces total mental health costs on average by $538 in a 6-month period. Tests of endogeneity were largely insignificant, except for the depression score that tested marginally statistically significant. Interaction terms between baseline MH scores and employment indicated larger employment effects for individuals with worse baseline scores. This study demonstrates the non-vocational benefits of employment for individuals with SMI. Results have high generalizability and should be of interest to federal and state governments in setting appropriate disability policy and funding vocational programs. From a methodological perspective, future research should still be concerned with potential endogeneity problems, especially if employment status and MH outcomes are simultaneously measured and/or baseline measures of MH are not adequately controlled for future research should continue to examine the multi-dimensional nature of MH status and costs. Our analyses also demonstrate the practical use of a state-wide outcomes measurement program in assessing the factors that influence the recovery trajectories of individuals with SMI.
就业对于患有严重精神疾病 (SMI) 的人来说是一个重要目标。目前的文献发现，就业与心理健康 (MH) 状况衡量指标之间存在一定的正相关关系，但研究设计问题使得无法进行因果解释。本研究旨在衡量就业对 SMI 患者的 MH 状况和总 MH 成本的因果效应。在准实验前瞻性设计中，使用基线、6 个月和 12 个月时自我报告的 MH 状况和就业数据，与公共精神卫生系统 (PMHS) 索赔数据相匹配。研究人群（N=5162）由接受 PMHS 服务一年或以上的 SMI 患者组成。因变量是 BASIS-24 工具的 MH 状况症状评分和总 MH 成本。估计方法是全信息极大似然法，允许检验就业的内生性。对于内生性检验不显著的结果，使用 Tobit 或普通最小二乘法（OLS）进行估计。就业对 MH 状况（包括整体 MH 状况、功能和关系）有适度但有意义的影响，并且在 6 个月内平均减少 538 美元的总心理健康成本。内生性检验大多不显著，除了抑郁评分略有统计学意义。基线 MH 评分与就业之间的交互项表明，基线评分较差的个体就业效果更大。本研究证明了就业对 SMI 患者的非职业益处。结果具有高度的普遍性，应该引起联邦和州政府的兴趣，以制定适当的残疾政策和资助职业项目。从方法论的角度来看，未来的研究仍应关注潜在的内生性问题，特别是如果就业状况和 MH 结果同时测量和/或基线 MH 测量没有充分控制的情况下。未来的研究应继续检查 MH 状况和成本的多维性质。我们的分析还展示了全州范围的结果测量计划在评估影响 SMI 患者康复轨迹的因素方面的实际用途。
