title: Clinical and cognitive predictors of vocational outcome in first-episode schizophrenia: a prospective 3 year follow-up study.
abstract: Schizophrenia is associated with pronounced vocational impairment. Previous research has mostly focused on chronic patients and few studies were conducted to investigate predictors of work outcome in first-episode populations. The impact of cognitive dysfunction on employment outcome in early psychosis was under-studied. In this study, we prospectively followed up 93 patients aged 18-55 years presented with first-episode schizophrenia-spectrum disorder for 3 years with an aim to identify early clinical and cognitive predictors of vocational outcome. Pre-morbid adjustment, baseline symptomatology and cognitive functions, and employment outcome were assessed. Result indicated that approximately half of the patients (53.8%) were engaged in full-time work at intake and at 3 years. Pre-morbid adjustment, baseline occupational status and Wisconsin Card Sorting Test (WCST) performance were found to predict vocational outcome. Analysis on a subgroup of patients who were unemployed at intake showed that subjects who remained unemployed over 3 years had poorer WCST performance and more severe positive symptoms at baseline than those having job attainment during follow-up. Our results thus confirmed predictive value of pre-morbid functioning and baseline occupational status on vocational outcome. In addition, our findings suggested that executive function might be a critical cognitive determinant of employment outcome in the early course of schizophrenia.
authors.affiliation: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong. Electronic address: changwc@hku.hk.
authors.forename: Wing Chung
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Jennifer Yee
authors.initials: JY
authors.lastname: Man Tang
authors.affiliation: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Christy Lai
authors.initials: CL
authors.lastname: Ming Hui
authors.affiliation: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Sherry Kit
authors.initials: SK
authors.lastname: Wa Chan
authors.affiliation: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong.
authors.forename: Edwin Ho
authors.initials: EH
authors.lastname: Ming Lee
authors.affiliation: Department of Psychiatry, the University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong; State Key Laboratory of Brain and Cognitive Sciences, the University of Hong Kong, Hong Kong.
authors.forename: Eric Yu
authors.initials: EY
authors.lastname: Hai Chen
mesh_terms: D000328:Adult; D003072:Cognition Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D015331:Cohort Studies; D004651:Employment / Q000523:psychology* / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012559:Schizophrenia / Q000175:diagnosis / Q000453:epidemiology*; D012565:Schizophrenic Psychology; D055815:Young Adult
keywords: Cognitive impairment; Employment; Executive function; First-episode schizophrenia; Vocational outcome