Cognitive correlates of job tenure among patients with severe mental illness.
OBJECTIVE
There is clear evidence that cognitive performance is a correlate of functional outcome among patients with schizophrenia. However, few studies have specifically examined the cognitive correlates of competitive employment performance or the longer-term outcomes of vocational rehabilitation. The objective of the present study was to examine the cognitive predictors of vocational functioning in the context of a controlled clinical trial by comparing two approaches to vocational rehabilitation.


METHODS
A broad neuropsychological battery was administered to 150 patients upon entry into the vocational rehabilitation trial. Vocational performance was assessed over a 24-month follow-up interval.


RESULTS
There were no differences in baseline cognitive performance between the 40 patients who obtained competitive employment and the 110 patients who remained unemployed over the follow-up interval. In contrast, multiple cognitive measures were significantly correlated with the total number of hours that patients were employed. The cognition-job tenure relationship appears to be fairly general, involving measures of IQ, attention, working memory, and problem solving.


CONCLUSIONS
Cognitive performance was a significant predictor of job tenure but not job attainment in the context of a clinical trial of two vocational rehabilitation approaches. It appears that many persistently unemployed patients are capable of obtaining competitive employment with effective vocational services. Longer-term employment success, however, may be related to multiple aspects of baseline cognitive performance.
Gold
James M
JM
Maryland Psychiatric Research Center and the Center for Mental Health Services Research, Department of Psychiatry, University of Maryland, Baltimore 21228, USA. jgold@mprc.umaryland.edu
Goldberg
Richard W
RW
McNary
Scot W
SW
Dixon
Lisa B
LB
Lehman
Anthony F
AF
D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000534:rehabilitation*; D009483:Neuropsychological Tests / Q000706:statistics & numerical data*; D017063:Outcome Assessment, Health Care; D011336:Probability; D012050:Rehabilitation, Vocational / Q000379:methods*; D012720:Severity of Illness Index