Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston (Szmulewicz); Psychotic Disorders Division, McLean Hospital, Belmont, Massachusetts (Öngür, Shinn, Carol, Dow, Yilmaz, Durning); Department of Psychiatry (Öngür, Shinn, Carol) and Department of Health Care Policy (Hsu), Harvard Medical School, Boston; Mongan Institute, Massachusetts General Hospital, Boston (Sastry, Hsu).
Psychiatr Serv. 2022 Feb 1;73(2):165-171. doi: 10.1176/appi.ps.202100114. Epub 2021 Jun 30.
A central objective of early psychosis therapy is to restore social functioning (e.g., through employment and education). Employment and educational outcomes during the COVID-19 pandemic were examined in a well-defined cohort of patients receiving care in an early psychosis clinic.
Data were extracted from the electronic health records of 128 patients receiving care at McLean Hospital's first-episode psychosis (FEP) clinic between January 1 and September 21 in 2019 and 2020. Using a generalized linear model with a Gaussian distribution and robust standard errors, the authors compared the average changes in the weekly employment and education proportions before and after COVID-19 lockdowns with the same changes in 2019.
Employment losses among patients with FEP were greater than among the general population and persisted through the end of follow-up. In 2020, average employment after a stay-at-home order was instituted was 33% lower than before the order compared with the change in employment during the same period in 2019. The effect was stronger among men and those who identified as non-White, were age <21 years, or did not have a college education. Although educational engagement recovered in the fall of 2020, it still remained below the 2019 levels.
Employment disruptions were major and persistent among the FEP population, which might affect short- and long-term outcomes. Innovative approaches are needed to help patients transition to remote employment, file unemployment claims, and use online hiring platforms to ameliorate the indirect effects of the COVID-19 pandemic.
早期精神病治疗的一个主要目标是恢复社会功能（例如，通过就业和教育）。本研究在一个明确的早期精神病诊所患者队列中检查了 COVID-19 大流行期间的就业和教育结果。
从 2019 年 1 月 1 日至 2020 年 9 月 21 日期间在麦克莱恩医院首次发病精神病（FEP）诊所接受治疗的 128 名患者的电子健康记录中提取数据。使用具有正态分布和稳健标准误差的广义线性模型，作者比较了 COVID-19 封锁前后每周就业和教育比例的平均变化与 2019 年同期的相同变化。
FEP 患者的就业损失大于一般人群，并持续到随访结束。2020 年，与 2019 年同期相比，在实行居家令后，平均就业水平下降了 33%。这种影响在男性和非白人、年龄<21 岁、没有大学学历的患者中更强。尽管 2020 年秋季教育参与度有所恢复，但仍低于 2019 年的水平。
FEP 人群的就业中断严重且持续，这可能会影响短期和长期结果。需要创新方法来帮助患者过渡到远程就业、申请失业救济金以及使用在线招聘平台，以减轻 COVID-19 大流行的间接影响。
