DIFFERENTIATING EMPLOYMENT TRAJECTORIES IN SCHIZOPHRENIA: FEATURES OF CURRENT, FORMERLY, AND NEVER EMPLOYED PATIENTS

Abstract Background The interplay between neurocognition, social cognition, and employment outcomes among the schizophrenic population has been extensively investigated, but there are disparities between the impairments that predict these outcomes. In this study, we aim to provide further insight by discriminating between factors that influence getting a job and sustaining employment. We hypothesized that neurocognitive factors would predict which individuals experienced challenges in ever getting a job, while interpersonal deficits, disruptive behavior, or psychosis would characterize individuals who were able to obtain a job but unable to keep it. Methods Patients (n=396) were between 18 and 70 years old and received a diagnosis of Schizophrenia, Schizoaffective Disorder or Schizophreniform Disorder. Performance-based assessments were conducted to measure neurocognition, social cognition and psychosis; and, clinical ratings provided information on psychosis, negative symptoms and disruptive behavior. Patients were divided into three clusters defined as: individuals who had never been employed (n=196), individuals who formerly had a job for at least 2 years but have been unemployed for at least 2 years (n=149), and individuals with current employment for at least 2 years (n=51). Results Patients who never had a job manifested the following characteristics compared to those who currently had a job: significantly fewer years of patient education (Self, p=.006), mother’s education (Mother, p=.028), and lower verbal working memory (LNS, p<.01). They also displayed significantly more PANSS social avoidance (p=.023), disturbance of volition (p=.037), and anxiety (p=.004). Compared to those who formerly had a job, these same patients manifested the following: significantly more total negative symptoms (p=.039), more severe poor rapport (p=.041) and more blunted affect (p=.002). Formerly employed patients reported significantly more depression (BDI, p=.01) and hostile cognitive bias (BLAME, p=.008), as well as worse emotional processing on the BLERT (p=.005) and ER-40 (p=.028) compared to the never employed group. Lastly, patients who formerly had a job manifested the following compared to those who currently had a job: less patient education (Self, p=.011), mother’s education (Mother, p=.015), premorbid intelligence (WRAT-3 Standard Score, p=.038), working memory (LNS, p<.01), and blunted affect (PANSS, p=.018). On the PANSS, they had more grandiosity (p=.031), suspiciousness (p=.008), anxiety (p=.001), active social avoidance (p=.003), and depression (p=.016). BDI total score, for depression, was also elevated [t(114)=3.58, p=001)]. Discussion Individuals who never had a job have evidence of less education and poorer working memory as well as negative and mood symptoms, when compared to those who were ever employed. Those who obtained a job but developed long-term unemployment had evidence of 1) social cognitive impairments, including hostile bias and emotion processing deficits, when compared to the never employed patients and 2) lower education, working memory, and PANSS ratings for negative symptoms, suspiciousness and grandiosity, when compared to the currently employed patients. Thus, the formerly employed patients manifested a constellation of symptoms that would seem to interfere with sustaining employment. Later research will be required to determine the time course of development that these predictors of unemployment have on patients who were previously able to work.