title: Effects of Sustained Competitive Employment on Psychiatric Hospitalizations and Quality of Life.
abstract: OBJECTIVE
  There is extensive evidence for the effectiveness of supported employment among people with severe mental illness. However, less research has been conducted to evaluate the effects of sustained competitive employment on nonvocational outcomes. The aim of this study was to evaluate the effects of sustained competitive work on quality of life and psychiatric hospitalizations.
  
  
  METHODS
  As part of a randomized controlled trial, a mediation analysis was used to compare the direct and indirect effects of supported employment versus a traditional vocational program on sustained competitive employment, days of psychiatric hospitalization, and quality of life among 85 participants over five years.
  
  
  RESULTS
  The five-year follow-up indicated that the effects of supported employment on reduced days of hospitalization and increased quality of life were fully mediated by the program's effects on increasing sustained competitive employment.
  
  
  CONCLUSIONS
  The rehabilitative and therapeutic dimensions of functional health conditions are interrelated in the long term. The achievement of sustained competitive employment may be a key factor in improving social and psychiatric outcomes for people with severe and persistent mental disorders.
authors.affiliation: Ms. Jäckel, Ms. Glauser, and Dr. Hoffmann are with the Center for Psychiatric Rehabilitation, and Dr. Kupper is with the Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern (e-mail: jaeckel@spk.unibe.ch ). Ms. Jäckel is also with the Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinical Center, Academic Hospital of Charite Medicine, Berlin. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.
authors.forename: Dorothea
authors.initials: D
authors.lastname: Jäckel
authors.affiliation: Ms. Jäckel, Ms. Glauser, and Dr. Hoffmann are with the Center for Psychiatric Rehabilitation, and Dr. Kupper is with the Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern (e-mail: jaeckel@spk.unibe.ch ). Ms. Jäckel is also with the Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinical Center, Academic Hospital of Charite Medicine, Berlin. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.
authors.forename: Zeno
authors.initials: Z
authors.lastname: Kupper
authors.affiliation: Ms. Jäckel, Ms. Glauser, and Dr. Hoffmann are with the Center for Psychiatric Rehabilitation, and Dr. Kupper is with the Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern (e-mail: jaeckel@spk.unibe.ch ). Ms. Jäckel is also with the Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinical Center, Academic Hospital of Charite Medicine, Berlin. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.
authors.forename: Sibylle
authors.initials: S
authors.lastname: Glauser
authors.affiliation: Ms. Jäckel, Ms. Glauser, and Dr. Hoffmann are with the Center for Psychiatric Rehabilitation, and Dr. Kupper is with the Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern (e-mail: jaeckel@spk.unibe.ch ). Ms. Jäckel is also with the Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinical Center, Academic Hospital of Charite Medicine, Berlin. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.
authors.forename: Kim T
authors.initials: KT
authors.lastname: Mueser
authors.affiliation: Ms. Jäckel, Ms. Glauser, and Dr. Hoffmann are with the Center for Psychiatric Rehabilitation, and Dr. Kupper is with the Department of Molecular Psychiatry, University Hospital of Psychiatry, University of Bern (e-mail: jaeckel@spk.unibe.ch ). Ms. Jäckel is also with the Department of Psychiatry, Psychotherapy and Psychosomatics, Vivantes Clinical Center, Academic Hospital of Charite Medicine, Berlin. Dr. Mueser is with the Center for Psychiatric Rehabilitation, Boston University, Boston.
authors.forename: Holger
authors.initials: H
authors.lastname: Hoffmann
mesh_terms: D000328:Adult; D016832:Employment, Supported / Q000379:methods*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006785:Hospitals, University; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000534:rehabilitation*; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D012044:Regression Analysis; D013557:Switzerland
keywords: Hospitalization; Outcome studies; Quality of life; Supported employment; Vocational rehabilitation