Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, UK.
Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.
Int J Soc Psychiatry. 2022 Nov;68(7):1315-1323. doi: 10.1177/00207640221104684. Epub 2022 Jul 7.
While employment programs were not created with the intent to improve common mental disorders (CMDs), they may have a positive impact on the prevalence, incidence, and severity of CMD by reducing poverty and increasing access to economic mobility.
To examine and synthesize the available quantitative evidence of the impact of employment programs on outcomes of CMD.
Embase, Econlit, Global Health, MEDLINE, APA PsychINFO, and Social Policy and Practice were searched for experimental and quasi-experimental studies which investigated the impact of employment programs on primary and secondary outcomes of a CMD. A narrative synthesis according to Popay was conducted. The methodological quality of studies was assessed with the Cochrane Risk of Bias tool and the Newcastle-Ottawa Assessment Scale.
Of the 1,327 studies retrieved, two randomized controlled trials, one retrospective cohort, one pilot study with a non-randomized experimental design, and one randomized field experiment were included in the final review. Employment programs generally included multiple components such as skills-based training, and hands-on placements. Depression and anxiety were the CMDs measured as primary or secondary outcomes within included studies. Findings regarding the impact of employment programs on CMD were mixed with two studies reporting significantly positive effects, two reporting no effects, and one reporting mixed effects. The quality among included studies was good overall with some concerns regarding internal validity.
Employment programs may support a decrease in the prevalence, incidence, and severity of CMDs. However, there is high heterogeneity among study effects, designs, and contexts. More research is needed to gain further insight into the nature of this association and the mechanisms of impact. This review highlights the potential for employment programs and other poverty-reduction interventions to be utilized and integrated into the wider care, prevention, and treatment of common-mental disorders.
虽然就业计划并非旨在改善常见精神障碍（CMD），但它们通过减少贫困和增加获得经济流动性的机会，可能对 CMD 的患病率、发病率和严重程度产生积极影响。
研究和综合现有关于就业计划对 CMD 结果影响的定量证据。
在 Embase、Econlit、Global Health、MEDLINE、APA PsychINFO 和 Social Policy and Practice 中搜索了实验和准实验研究，这些研究调查了就业计划对 CMD 的主要和次要结果的影响。根据 Popay 进行了叙述性综合。使用 Cochrane 偏倚风险工具和纽卡斯尔-渥太华评估量表评估研究的方法学质量。
在检索到的 1327 项研究中，最终综述纳入了两项随机对照试验、一项回顾性队列研究、一项非随机实验设计的试点研究和一项随机实地试验。就业计划通常包括多种组成部分，如技能培训和实践安置。抑郁和焦虑是纳入研究中测量的主要或次要 CMD。关于就业计划对 CMD 影响的研究结果喜忧参半，两项研究报告有显著积极影响，两项研究报告无影响，一项研究报告混合影响。纳入研究的总体质量较好，但内部有效性存在一些问题。
就业计划可能有助于降低 CMD 的患病率、发病率和严重程度。然而，研究效果、设计和背景存在高度异质性。需要进一步的研究来更深入地了解这种关联的性质和影响机制。本综述强调了就业计划和其他减贫干预措施的潜力，可将其用于和整合到更广泛的常见精神障碍的护理、预防和治疗中。
