College of Health and Rehabilitation Sciences: Sargent College, Boston University, 635 Commonwealth Ave, Boston, MA, 02215, USA.
Center for Psychiatric Rehabilitation, Boston University, 940 Commonwealth Ave. West, Boston, MA, 02215, USA.
Soc Psychiatry Psychiatr Epidemiol. 2020 Dec;55(12):1593-1606. doi: 10.1007/s00127-020-01901-0. Epub 2020 Jun 20.
Research on employment in people with severe mental illnesses (SMI) in developing countries is sparse and largely limited to employment rates. We conducted a comprehensive study of work, interest in work, and perceived benefits and barriers to work in people with SMI in India.
Semi-structured interviews were conducted with 550 individuals with SMI receiving private psychiatric outpatient services in two districts in western India, one urban (Pune) and the other rural (Ahmednagar).
More than half of the participants were employed, with significantly more men working (79.4%) than women (35.9%). Higher rates of work were found in rural areas (77.8%), where most work was in family agricultural businesses, than in urban areas (48.9%), where most work was for independent employers. Participants in rural areas worked fewer hours and earned less money, and reported fewer benefits and fewer problems related to work than urban participants. Over 45% of participants working for independent employers found jobs with help from families and extended social networks. Most unemployed participants wanted to work, and desired a variety of supports, including assistance with job finding and illness management.
Gender-specific social role expectations and families play an important role in work in people with SMI in India. Despite higher rates of work in this sample than most studies from developed countries, a significant subgroup was unemployed but wanted to work. Persons with SMI in developing countries may benefit from the adaptation of validated vocational rehabilitation approaches in developed countries to their cultural context.
发展中国家针对严重精神疾病（SMI）患者就业问题的研究较少，且主要集中在就业率上。我们对印度 SMI 患者的工作、工作兴趣以及对工作的认知益处和障碍进行了全面研究。
对印度西部两个地区（城市浦那和农村艾哈迈德纳加尔）私人精神病门诊服务的 550 名 SMI 患者进行了半结构化访谈。
超过一半的参与者有工作，其中男性（79.4%）的工作比例明显高于女性（35.9%）。农村地区（77.8%）的工作比例更高，其中大多数工作是在家庭农业企业中，而城市地区（48.9%）的工作则是为独立雇主工作。农村地区的参与者工作时间更短，收入更低，报告的工作益处和与工作相关的问题也比城市参与者少。超过 45%的为独立雇主工作的参与者在家庭和扩大的社会网络的帮助下找到了工作。大多数失业的参与者都想工作，并希望得到各种支持，包括帮助寻找工作和疾病管理。
特定于性别的社会角色期望和家庭在印度 SMI 患者的工作中起着重要作用。尽管该样本中的工作率高于大多数来自发达国家的研究，但仍有一个很大的未就业但希望工作的亚组。发展中国家的 SMI 患者可能会受益于对发达国家经过验证的职业康复方法进行适应，以适应其文化背景。
