Preventing Poor Vocational Functioning in Psychosis Through Early Intervention.

Wenche Ten Velden Hegelstad Kolbjorn S Bronnick Helene Eidsmo Barder Julie Horgen Evensen Ulrik Haahr Inge Joa Jan Olav Johannessen Johannes Langeveld Tor Ketil Larsen Ingrid Melle Stein Opjordsmoen Bjørn Rishovd Rund Jan Ivar Rossberg Erik Simonsen Per Wiggen Vaglum Thomas H McGlashan Svein Friis

Psychiatr Serv

Dr. Hegelstad, Prof. Dr. Bronnick, Dr. Joa, Prof. Dr. Johannessen, Dr. Langeveld, and Prof. Dr. Larsen are with the Regional Centre for Clinical Research in Psychosis, Psychiatric Division, Stavanger University Hospital, Stavanger, Norway (e-mail: ). Prof. Dr. Bronnick, Dr. Joa, and Prof. Dr. Johannessen are also with the Faculty of Social Sciences, University of Stavanger, Stavanger, Norway. Prof. Dr. Larsen is also with the Institute of Clinical Medicine, University of Bergen, Bergen, Norway. Dr. Barder is with the Women and Children's Division, and Prof. Dr. Friis is with the Division of Mental Health and Addiction, Oslo University Hospital, Oslo. Prof. Dr. Friis is also with the Institute of Clinical Medicine, University of Oslo, Oslo, where Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are affiliated. Prof. Dr. Melle, Prof. Dr. Opjordsmoen, and Prof. Dr. Rossberg are also with the Division of Mental Health and Addiction, Oslo University Hospital, Ullevål, Oslo, where Dr. Evensen is affiliated. Dr. Haahr and Prof. Dr. Simonsen are with the Faculty of Health and Medical Sciences, Institute for Clinical Medicine, University of Copenhagen, Smedegade, Roskilde, Denmark. They are also with the Psychiatric Research Unit, Psychiatry Region Zealand, Toftegade, Roskilde, Denmark. Prof. Dr. Rund is with the Department of Psychology, and Prof. Dr. Vaglum is with the Department of Behavioral Sciences in Medicine, University of Oslo, Oslo. Prof. Dr. Rund is also with the Vestre Viken Hospital Trust, Drammen, Norway. Dr. McGlashan is with the School of Medicine, Yale University, New Haven, Connecticut.

Published: January 2017

Objective: This study tested the hypothesis that early detection of psychosis improves long-term vocational functioning through the prevention of negative symptom development.

Methods: Generalized estimating equations and mediation analysis were conducted to examine the association between employment and negative symptoms over ten years among patients in geographic areas characterized by usual detection (N=140) or early detection (N=141) of psychosis.

Results: Improved vocational outcome after ten years among patients in the early-detection area was mediated by lower levels of negative symptoms during the first five years. Regardless of symptoms, rates of full-time employment or study were lower among patients in the usual-detection versus the early-detection area.

Conclusions: Patients from an early-detection area attained lower negative symptom levels earlier compared with patients from a usual-detection area, which seemed to have facilitated vocational careers.

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http://dx.doi.org/10.1176/appi.ps.201500451	DOI Listing

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