title: Long-term employment among people at ultra-high risk for psychosis.
abstract: Psychotic disorders are associated with high rates of sustained unemployment, however, little is known about the long-term employment outcome of people at ultra-high risk (UHR) of developing psychosis. We sought to investigate the long-term unemployment rate and baseline predictors of employment status at follow-up in a large UHR cohort.
  
  
  
  268 UHR patients recruited from the Personal Assessment and Crisis Evaluation clinic in Melbourne, Australia were followed-up over 2-14years after initial presentation to the service. Individuals in no form of employment or education were classed as unemployed. Logistic regression analyses were used to examine predictors of employment outcome.
  
  
  
  A high rate of unemployment was present at follow-up in this UHR sample (23%). At baseline, those who were unemployed at follow-up had a longer duration of untreated illness, more severe negative symptoms, lower IQ, poorer social and occupational functioning and reported more childhood trauma than the employed group. At follow-up, unemployed individuals exhibited significantly more severe symptoms on all measures and were more likely to have been diagnosed with a mood, anxiety, psychotic or substance use disorder. Childhood trauma and the duration of untreated illness at baseline were significant independent predictors of employment status at follow-up in the multivariate analyses.
  
  
  
  Nearly a quarter of this UHR sample was unemployed at long-term follow-up. The duration of untreated illness and the effects of childhood trauma are potentially modifiable risk factors for long-term employment outcome in this group. Vocational support may be beneficial for many UHR patients presenting to services.
authors.affiliation: Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK. Electronic address: jack.cotter@manchester.ac.uk.
authors.forename: Jack
authors.initials: J
authors.lastname: Cotter
authors.affiliation: Telethon Kids Institute, The University of Western Australia, Australia.
authors.forename: Ashleigh
authors.initials: A
authors.lastname: Lin
authors.affiliation: Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Drake
authors.affiliation: Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Thompson
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
authors.forename: Barnaby
authors.initials: B
authors.lastname: Nelson
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
authors.forename: Patrick
authors.initials: P
authors.lastname: McGorry
authors.affiliation: Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; School of Psychology, University of Birmingham, Birmingham, UK.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Wood
authors.affiliation: Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK.
authors.forename: Alison R
authors.initials: AR
authors.lastname: Yung
mesh_terms: D000293:Adolescent; D000328:Adult; D000069586:Adult Survivors of Child Adverse Events / Q000706:statistics & numerical data*; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011618:Psychotic Disorders / Q000453:epidemiology* / Q000503:physiopathology*; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D014739:Victoria / Q000453:epidemiology; D055815:Young Adult
keywords: At-risk mental state; Employment; Functioning; Psychosis; Ultra-high risk