Research confirms that workers with disabilities have high unemployment rates. Among this group, less is known about barrier to employment for individuals with psychiatric disabilities, especially those who receive vocational rehabilitation services. Information about this could help improve service delivery.
This study examined the impact of unemployment rates on the outcomes of individuals with psychiatric disabilities who were participating in supported employment services.
The setting was multiple community job sites across 7 states where individuals with psychiatric disabilities went to work.
Participants include 1,273 individuals with psychiatric disabilities from seven states, who were randomly assigned to experimental supported employment (51%) or services as usual(49%) for 24 months. There were approximately equal numbers of males and females. About 50% of the group were non minority. The median age of the participants was 38 years and around one third (35%) had a less than a high school education. The most prevalent diagnosis was schizophrenia (31%) followed by schizoaffective disorder, major depression and bipolar disorder. Almost all participants were prescribed medications at baseline.
Interviews were used to gain information about demographics, employment histories, income sources and amounts, clinical symptoms and other relevant information at the beginning of the study and then at 6 month intervals for 24 months. A variety of employment data was gathered such as hours worked, wages, job duties, benefits. Psychiatric symptoms were assessed using the PANSS a semi structured rating scale.
Bivariate analysis were conducted to test for significant differences in study conditions. Two vocational outcome variables were computed for every month of the 24 month follow up period: competitive employment and work for 40 or more hours in a single month. The independent variable was the local unemployment rate for the geographic area surrounding each program. Some demographic and clinical covariates that should be included in multivariate models predicting employment were excluded due to their high correlation with other variables.
Unemployment rates over times were inspected for each of the seven counties in which study sites were located. Then hierarchical random regression analysis using time varying and fixed covariates were used to determine the effect of unemployment rate on each of the two employment outcomes. Random effects logistic regression modeling, addressed issues found in longitudinal multi-site data such as missing observations, fixed versus time varying covariates and more.
The intervention was the Individual Placement and Support Model of supported employment for individuals with mental illness.
The control was typical vocational rehabilitation services.
Participants residing in areas with low unemployment rates who received evidenced based Supported employment services had consistently better outcomes than all others. This included those who received evidence based supported employment services in areas with high unemployment. The study condition and employment rate were significant predictors of both competitive employment and working 40 or more hours a month.
Evidenced based supported employment can help improve the effects of high unemployment on work outcomes for individuals with psychiatric disabilities. The labor market influences employment outcomes for individuals with psychiatric disabilities who are participating in vocational rehabilitation programs. Individuals who reside in areas with high unemployment rates are likely to have poor outcomes if they do not receive high quality supported employment services.