Effects of co-occurring disorders on employment outcomes in a multisite randomized study of supported employment for people with severe mental illness

Authors: Cooper, R. A., Boninger, M. L., Cooper, R., Fitzgerald, S. G., & Kellerher, A.
Year Published 2007
Publication Journal of Rehabilitation Research and Development
Volume 44
Number 6
Pages 837-850
Publisher United States Department of Veterans Affairs

A growing body of literature indicates the high prevalence of medical disorders among people with severe mental illness, including cardiovascular disease, tuberculosis, and diseases of the lungs, kidneys, and digestive tract. In addition, substance use is perhaps the most frequently identified co-occurring disorder among psychiatric outpatients. Other common co-occurring disorders include ADHD and cognitive disabilities. Each of these may influence employment outcomes.


The purposes of this study are to (1) examine the effects of co-occurring disorders on employment and earnings; (2) assess the efficacy of a supported employment approach for individuals with severe mental illnesses and co-occurring disorders, and (3) assess the impact of co-occurring disorders on decisions to disclose disability to employers and prospective employers.


This study was conducted in eight study sites of the Employment Intervention Demonstration Program (EIDP). The sites were located in Maryland, Connecticut, South Carolina, Pennsylvania, Arizona, Massachusetts, Maine, and Texas.


The study sample consisted of 1,273 individuals who were clients of one of the EIDP demonstration sites. Participants were at age 18 and over, with a confirmed diagnosis of severe and persistent mental illness. Individuals were excluded who were working at randomization, were involved in a trial of another intervention, or had no vocational outcome data.

Data Collection

Data collection consisted of chart review protocol for collecting comorbidity data used in this analysis. Interview assessments with EIDP participants elicited information regarding demographic characteristics, employment history, and other relevant information at the time of study enrollment (baseline) and at 6-month follow-up intervals for 24 months. Vocational data were collected weekly and included job tenure, hours worked, earnings, job characteristics, and workplace disclosure of psychiatric disability. Data analysis included ordinary least-squares regression for the multivariate analysis of interval-level dependent variables and logistic regression for dichotomous outcomes.


Sites elected to use one of two types of control conditions: (1) services-as-usual or (2) a comparison condition that was lacking the active ingredient being-tested in the site experimental condition. The services-as-usual control condition was by whatever services were typically available in the local community.


More than half (59.9%) the study participants were reported to have one or more comorbidities. Individuals in experimental conditions had significantly higher employment rates, earnings, and work hours per week. Rates of disclosure were not different between experimental and control conditions. Those with any comorbidity had lower earnings. Those with comorbidities affecting physical functioning had significantly lower employment rates and less work hours than those other or no comorbidities. Individuals with comorbidities affecting both physical and cognitive functioning were more than twice as likely to disclose; individuals with learning disabilities were more than three times as likely to disclose.


The study findings point to the influence of co-occurring disorders in employment outcomes for individuals with severe mental illness in supported employment. Those in the experimental conditions had better employment outcomes regardless of comorbidities, evidencing the value of supported employment models for this population.

URL http://www.worksupport.com/kter/documents/pdf/CookErrectsofCooccuringDisordersonEmployOutcomes1.pdf
Disabilities Emotional disturbance
Populations Male & Female | Rural | Urban
Outcomes Employment acquisition
NIDILRR Funded Yes
Research Design Randomized Controlled Trials (RCTs)
Peer Reviewed Yes