Fraser Health Early Psychosis Intervention Program, New Westminster, British Columbia, Canada.
Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
Early Interv Psychiatry. 2021 Jun;15(3):662-668. doi: 10.1111/eip.13005. Epub 2020 Jun 24.
Individual Placement and Support is an effective vocational intervention for increasing competitive employment for people with severe mental illness. Little is known, however, about its effectiveness in the context of early psychosis. This study assesses improvements in clients' employment in a phase of illness during which functional abilities often decline.
The trial design is an assessor-blinded randomized clinical trial, set in the context of a population-based Early Psychosis Intervention program in British Columbia, Canada. Participants were randomized either to 1 year of employment support added to treatment-as-usual, or the latter alone. Interviews at intake captured data regarding demographics, symptom severity, and employment; assessments at 6 and 12 months repeated queries about employment activities.
A total of 109 clients were recruited. Employment rates in the Individual Placement and Support group increased over time, unlike the control group. Further, the number of days worked over the 12-month intervention period, compared to the 6 months prior to the study, improved for both groups, but the increase was greater among clients receiving IPS. Sensitivity analysis indicated the advantage in days worked was evident in the second half of the intervention period (6-12 months), but not the first half.
Employment rates, for younger clients in both early-psychosis groups, were high compared to older clients in later stages of illness. In this study, use of the Individual Placement and Support strategy further increased employment, despite the high baseline rates. Further research is needed to identify the optimal timing of employment support for these clients.
个体安置与支持是一种有效的职业干预措施，可提高严重精神疾病患者的竞争性就业机会。然而，对于其在早期精神病中的有效性，人们知之甚少。本研究评估了在功能能力经常下降的疾病早期阶段，客户就业的改善情况。
该试验设计为评估员盲法随机临床试验，设置在加拿大不列颠哥伦比亚省基于人群的早期精神病干预计划的背景下。参与者被随机分配到接受 1 年就业支持附加治疗与仅接受后者。在入组访谈中，收集了有关人口统计学、症状严重程度和就业的数据；在 6 个月和 12 个月的评估中，重复了有关就业活动的查询。
共招募了 109 名患者。与对照组相比，个体安置与支持组的就业人数随着时间的推移而增加。此外，与研究前 6 个月相比，两组在 12 个月干预期间的工作天数都有所增加，但接受 IPS 的患者增加幅度更大。敏感性分析表明，在干预期间的后半段（6-12 个月），工作天数的增加更为明显，而在前半段则不明显。
与处于疾病后期的年龄较大的患者相比，早期精神病组中的年轻患者的就业率较高。在这项研究中，尽管基线率较高，使用个体安置与支持策略还是进一步增加了就业机会。需要进一步研究以确定为这些患者提供就业支持的最佳时机。
