title: Employment outcome and predictors of competitive employment at 2-year follow-up of a vocational rehabilitation programme for individuals with schizophrenia in a high-income welfare society.
abstract: BACKGROUND
  Employment is an important part of recovery for individuals with schizophrenia. The employment rate for this group is as low as 10% in Norway, and major system related barriers to employment are evident.
  
  
  OBJECTIVE
  This study reports the competitive employment outcome at 2-year follow-up of a vocational rehabilitation study augmented with cognitive remediation (CR) or elements from cognitive behaviour therapy (CBT) for individuals with schizophrenia spectrum disorders. It also investigates if global functioning, self-esteem, and depression at baseline predicts employment outcome, and if change in these variables during the intervention period is associated with employment outcome.
  
  
  METHODS
  One hundred and forty-eight participants with schizophrenia spectrum disorders in six Norwegian counties received 10 months vocational rehabilitation augmented with either CBT (n = 84) or CR (n = 64). Both competitive and sheltered workplaces were used. Participants were assessed at baseline, at the end of the intervention period, and at 2-year follow-up.
  
  
  RESULTS
  At 2-year follow-up, 21.2% had obtained competitive employment. A further 25.3% had work placements in competitive workplaces. Significant improvements were found in global functioning, self-esteem, and depression during the intervention period, but no significant differences between the two intervention groups. High baseline global functioning and self-esteem, as well as positive change in these variables during the intervention period, were significantly associated with higher competitive employment outcome at 2-year follow-up.
  
  
  CONCLUSIONS
  The results add to existing evidence that competitive employment is attainable for individuals with schizophrenia. High global functioning and self-esteem were strongly associated with competitive employment outcome.
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.
authors: Stig
authors: S
authors: Evensen
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.|b Department of Psychology , University of Oslo , Oslo , Norway.
authors: Torill
authors: T
authors: Ueland
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.
authors: June Ullevoldsæter
authors: JU
authors: Lystad
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.
authors: Helen
authors: H
authors: Bull
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.|c Oslo Center for Biostatistics and Epidemiology , Oslo University Hospital , Oslo , Norway.
authors: Ole
authors: O
authors: Klungsøyr
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.|d Department of Clinical Medicine , University of Oslo , Oslo , Norway.
authors: Egil W
authors: EW
authors: Martinsen
authors: a Department of Research, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.|d Department of Clinical Medicine , University of Oslo , Oslo , Norway.
authors: Erik
authors: E
authors: Falkum
mesh_terms: D000328:Adult; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D012050:Rehabilitation, Vocational / Q000706:statistics & numerical data*; D012559:Schizophrenia / Q000534:rehabilitation*; D012649:Self Concept; D055815:Young Adult
keywords: Schizophrenia; employment outcome; global functioning; self-esteem; vocational rehabilitation