title: Mortality among patients with schizophrenia and vocational rehabilitation program services under Taiwan's psychiatric care reform.
abstract: BACKGROUND
  Vocational rehabilitation programs are implemented to enhance the occupational functioning of long-stay patients with schizophrenia. Unemployment is associated with a higher risk of death. Schizophrenia patients who participate in vocational rehabilitation programs may have better health outcomes with participation in employment.
  
  
  OBJECTIVE
  To evaluate the relationship between mortality among schizophrenia patients and vocational rehabilitation program services under Taiwan's psychiatric care reform.
  
  
  METHODS
  A total of 2457 long-stay schizophrenia patients were followed-up retrospectively from 1998 to 2008 at Taipei Veterans General Hospital Yuli Branch in Taiwan. We collected data on annual measurements of effectiveness and the human resources utilized in the vocational rehabilitation program. Pearson's correlations between the above-collected data and the crude death rates for all patients were examined. We also assessed the association between participation in supported or sheltered employment and death.
  
  
  RESULTS
  Most of the patients were male (81.3 %). The mean ± SD age of the patients was 57.8 ± 17.0 years. The annual crude death rate averaged 5.3 %. Both the number of community workplaces and the total wages earned from sheltered and supported employment had significantly negative linear correlations with the crude death rate among all patients (both γ ≤ -0.64, p < 0.05). After controlling the confounding factors, participation in supported or sheltered employment was significantly associated with a lower risk of death (n = 2174, HR = 0.22, 95 % CI 0.16-0.29).
  
  
  CONCLUSIONS
  Under psychiatric care reform, the vocational rehabilitation program was more effective and there was less patient mortality. Patients who had experienced sheltered or supported employment had a lower risk of death than those who had not.
authors.affiliation: Department of Psychiatry, Taipei Veterans' General Hospital Yuli Branch, No. 91, XinXing Rd., Yuli Township, 980 Hualien County Taiwan.
authors.forename: Kan-Yuan
authors.initials: KY
authors.lastname: Cheng
authors.affiliation: Department of Public Health, Tzu Chi University, No. 701, Zhongyang Rd., Sec. 3, Hualien City, 970 Hualien County Taiwan.
authors.forename: Shu-Yuan
authors.initials: SY
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Taipei Veterans' General Hospital Yuli Branch, No. 91, XinXing Rd., Yuli Township, 980 Hualien County Taiwan.
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Lin
keywords: Community facility; Death rate; Non-vocational outcome; Supported employment