The relative contribution of neurocognition and social cognition to 6-month vocational outcomes following Individual Placement and Support in first-episode psychosis.
OBJECTIVE
To examine whether baseline neurocognition and social cognition predict vocational outcomes over 6 months in patients with first-episode psychosis (FEP) enrolled in a randomised controlled trial of Individual Placement and Support (IPS) versus treatment as usual (TAU).


METHODS
135 FEP participants (IPS n=69; TAU n=66) completed a comprehensive neurocognitive and social cognitive battery. Principal axis factor analysis using PROMAX rotation was used to determine the underlying cognitive structure of the battery. Setwise (hierarchical) logistic and multivariate linear regressions were used to examine predictors of: (a) enrolment in education and employment; and (b) hours of employment over 6 months. Neurocognition and social cognition factors were entered into the models after accounting for premorbid IQ, baseline functioning and treatment group.


RESULTS
Six cognitive factors were extracted: (i) social cognition; (ii) information processing speed; (iii) verbal learning and memory; (iv) attention and working memory; (v) visual organisation and memory; and (vi) verbal comprehension. Enrolment in education over 6 months was predicted by enrolment in education at baseline (p=.002) and poorer visual organisation and memory (p=.024). Employment over 6 months was predicted by employment at baseline (p=.041) and receiving IPS (p=.020). Better visual organisation and memory predicted total hours of paid work over 6 months (p<.001).


CONCLUSIONS
Visual organisation and memory predicted the enrolment in education and duration of employment, after accounting for premorbid IQ, baseline functioning and treatment. Social cognition did not contribute to the prediction of vocational outcomes. Neurocognitive interventions may enhance employment duration in FEP.
Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Australia. Electronic address: kallott@unimelb.edu.au.
Kelly A
KA
Allott
Susan M
SM
Cotton
Gina L
GL
Chinnery
Gennady N
GN
Baksheev
Jessica
J
Massey
Pamela
P
Sun
Zoe
Z
Collins
Emma
E
Barlow
Christina
C
Broussard
Tasha
T
Wahid
Tina-Marie
TM
Proffitt
Henry J
HJ
Jackson
Eoin
E
Killackey
D000293:Adolescent; D003072:Cognition Disorders / Q000209:etiology* / Q000534:rehabilitation; D004651:Employment; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011569:Psychiatric Status Rating Scales; D011618:Psychotic Disorders / Q000150:complications / Q000523:psychology / Q000534:rehabilitation; D012050:Rehabilitation, Vocational / Q000379:methods*; D012919:Social Behavior; D055815:Young Adult
Early psychosis; Employment duration; Neurocognition; Social cognition; Supported employment; Vocational outcomes