title: The relationships between employment, clinical status, and psychiatric hospitalisation in patients with schizophrenia receiving either IPS or a conventional vocational rehabilitation programme.
abstract: OBJECTIVE
  Positive relationships between employment and clinical status have been found in several studies. However, an unequivocal interpretation of these relationships is difficult on the basis of common statistical methods.
  
  
  METHODS
  In this analysis, a structural equation model approach for longitudinal data was applied to identify the direction of statistical relationships between hours worked, clinical status and days in psychiatric hospital in 312 persons with schizophrenia who participated in a multi-centre randomised controlled trial comparing the effectiveness of Individual Placement and Support (IPS) with conventional vocational services in six study settings across Europe. Data were analysed by an autoregressive cross-lagged effects model, an autoregressive cross-lagged model with random intercepts and an autoregressive latent trajectory model.
  
  
  RESULTS
  Comparison of model fit parameters suggested the autoregressive cross-lagged effects model to be the best approach for the given data structure. All models indicated that patients who received an IPS intervention spent more hours in competitive employment and, due to indirect positive effects of employment on clinical status, spent fewer days in psychiatric hospitals than patients who received conventional vocational training.
  
  
  CONCLUSIONS
  Results support the hypothesis that the IPS intervention has positive effects not only on vocational but also on clinical outcomes in patients with schizophrenia.
authors.affiliation: Department of Psychiatry and Psychotherapy II, University of Ulm, Bezirkskrankenhaus Günzburg, Ludwig-Heilmeyer-Str. 2, 89312, Günzburg, Germany. reinhold.kilian@bkh-guenzburg.de
authors.forename: Reinhold
authors.initials: R
authors.lastname: Kilian
authors.forename: Christoph
authors.initials: C
authors.lastname: Lauber
authors.forename: Rana
authors.initials: R
authors.lastname: Kalkan
authors.forename: Wulf
authors.initials: W
authors.lastname: Dorn
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
authors.forename: Durk
authors.initials: D
authors.lastname: Wiersma
authors.forename: Jooske T
authors.initials: JT
authors.lastname: van Buschbach
authors.forename: Angelo
authors.initials: A
authors.lastname: Fioritti
authors.forename: Toma
authors.initials: T
authors.lastname: Tomov
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Catty
authors.forename: Tom
authors.initials: T
authors.lastname: Burns
authors.forename: Thomas
authors.initials: T
authors.lastname: Becker
mesh_terms: D000328:Adult; D000368:Aged; D016832:Employment, Supported / Q000379:methods* / Q000706:statistics & numerical data; D005060:Europe; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006778:Hospitals, Psychiatric; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015233:Models, Statistical; D010361:Patients / Q000523:psychology / Q000706:statistics & numerical data*; D011788:Quality of Life; D012050:Rehabilitation, Vocational / Q000379:methods* / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000534:rehabilitation*; D012919:Social Behavior; D012944:Social Support; D012959:Socioeconomic Factors; D016896:Treatment Outcome
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