Early Psychosis Intervention Program, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
Research Division, Institute of Mental Health, Buangkok Green Medical Park, 10 Buangkok View, 539747, Singapore.
Schizophr Res. 2019 Sep;211:63-68. doi: 10.1016/j.schres.2019.07.009. Epub 2019 Jul 19.
Most studies on predictors of vocational outcomes are cross-sectional and results are varied. This study aimed to examine the vocational rates of patients with first-episode psychosis (FEP), identify factors predicting a lack of engagement in age-appropriate roles, and evaluate the predictive ability of a model with baseline sociodemographic information and 2-year symptom and functioning trajectories on vocational outcomes. The Singapore Early Psychosis Intervention Program (EPIP) has maintained a standing database on patient clinico-demographic information. The primary outcome, vocational status, was operationalized as "meaningfully employed", that is, being gainfully employed or engaged in an age-appropriate role, and "unemployed". Using logistic regression, the predictive ability of the proposed model was evaluated. Vocational data was available for 1177 patients accepted into EPIP between 2001 and 2012. At the end of two years in the service, 829 (70.4%) patients were meaningfully employed and 348 (29.6%) patients were unemployed. The binary logistic regression model on the prediction of 2-year vocational outcomes yielded an AUC of 0.759 (SE = 0.016, p-value < 0.001). Clinico-demographic risk factors for being unemployed at the end of two years included being Malay, single, and unemployed at baseline; having a longer duration of untreated psychosis (DUP); a diagnosis of schizophrenia, schizophreniform, or delusional disorder at baseline; and belonging to the 'delayed response' or 'slower response and no response' general psychopathology trajectories. We have proposed a model that allows vocational outcomes to be predicted with high specificity. The results of this study will be relevant in developing future intervention models to improve outcomes among FEP patients with different illness trajectories.
大多数关于职业结果预测因素的研究都是横断面研究，结果各不相同。本研究旨在检查首发精神病（FEP）患者的职业率，确定预测缺乏适当年龄角色参与的因素，并评估基于基线社会人口统计学信息和 2 年症状和功能轨迹的模型对职业结果的预测能力。新加坡早期精神病干预计划（EPIP）一直维护着一个关于患者临床人口统计学信息的数据库。主要结局是职业状况，定义为“有意义地就业”，即有收益地就业或从事适当年龄的角色，以及“失业”。使用逻辑回归，评估了所提出模型的预测能力。在 2001 年至 2012 年间，有 1177 名患者被纳入 EPIP，其中有职业数据。在服务的两年结束时，829 名（70.4%）患者有意义地就业，348 名（29.6%）患者失业。用于预测 2 年职业结果的二项逻辑回归模型产生了 AUC 为 0.759（SE=0.016，p 值<0.001）。在两年结束时失业的临床人口统计学危险因素包括马来人、单身和基线失业；未治疗精神病（DUP）时间较长；基线时诊断为精神分裂症、精神分裂样或妄想障碍；以及属于“延迟反应”或“反应较慢和无反应”一般精神病理学轨迹。我们提出了一个可以高度特异性地预测职业结果的模型。本研究的结果将有助于制定未来的干预模型，以改善具有不同疾病轨迹的 FEP 患者的结局。
