Center for Life Course Health Research, University of Oulu, P.O. Box 5000, 90014, Oulu, Finland.
Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
Soc Psychiatry Psychiatr Epidemiol. 2023 Jan;58(1):65-76. doi: 10.1007/s00127-022-02327-6. Epub 2022 Jul 7.
Psychoses are associated with poor labour market attachment, but few studies have compared schizophrenia (SZ) and other psychoses (OP). Moreover, studies on long-term employment trajectories over individuals' working life courses are lacking. We compared 30 year employment trajectory patterns in a general population sample among individuals with SZ, OP, and those with no psychosis (NP).
Utilising the Northern Finland Birth Cohort 1966, we collected survey data on employment from ages 16 to 45 and detected individuals with register-based history of SZ (n = 62), OP (n = 87), or NP (n = 6464) until age 46. Through gender-specific latent class analyses on annual employment roles, we identified traditional, highly educated, self-employed, delayed and floundering employment trajectories with distinct socioeconomic characteristics. We addressed attrition by conducting weighted analyses.
Floundering trajectories were common among individuals with SZ (79% of men, 73% of women) and OP (52% of men, 51% of women). In NP, a traditional employee trajectory was most common in men (31%), and a highly educated trajectory in women (28%). A history of psychosis was associated with heightened odds ratios (ORs; 95% confidence intervals (CIs)) for floundering trajectories in both men (SZ: 32.9 (13.3-81.4); OP: 7.4 (4.0-13.9)) and women (SZ: 9.9 (4.6-21.5); OP: 3.9 (2.1-7.1)) compared to NP. Weighted analyses produced similar results.
Most individuals with SZ or OP have floundering employee trajectories reflecting an elevated risk of unemployment and part-time work until midlife. These results indicate the importance of improving labour market attachment during the early phases of psychoses.
精神病与劳动力市场参与度低有关，但很少有研究比较精神分裂症（SZ）和其他精神病（OP）。此外，关于个体整个工作生涯中长期就业轨迹的研究也很少。我们比较了一般人群样本中 SZ、OP 和无精神病（NP）个体在 30 年工作生涯中的就业轨迹模式。
利用芬兰北部出生队列 1966 年的数据，我们从 16 岁到 45 岁收集了就业调查数据，并通过登记的 SZ（n=62）、OP（n=87）或 NP（n=6464）个体的病史，随访至 46 岁。通过对每年的就业角色进行性别特异性潜在类别分析，我们确定了具有不同社会经济特征的传统、高学历、自营职业、延迟和艰难就业轨迹。我们通过加权分析解决了流失问题。
SZ（男性 79%，女性 73%）和 OP（男性 52%，女性 51%）个体中，艰难就业轨迹很常见。在 NP 中，男性最常见的是传统员工轨迹（31%），女性最常见的是高学历轨迹（28%）。有精神病病史与男性（SZ：32.9（13.3-81.4）；OP：7.4（4.0-13.9））和女性（SZ：9.9（4.6-21.5）；OP：3.9（2.1-7.1））的艰难就业轨迹的比值比（OR；95%置信区间（CI））显著升高，与 NP 相比。加权分析得出了相似的结果。
大多数 SZ 或 OP 个体都有艰难的就业轨迹，反映出中年前失业和兼职工作的风险增加。这些结果表明，在精神病的早期阶段，改善劳动力市场参与度非常重要。
