Employment programmes for schizophrenia and other severe mental illness in psychosocial rehabilitation: a systematic review

Introduction Employment programmes for people with mental illness vary widely in range, but nonetheless all share the same objectives of restoring or initiating vocational roles to promote recovery in psychosocial rehabilitation. The current interventions available usually focus on the specific vocational outcomes of the intervention rather than focusing holistically on the client’s needs. Method This review aimed to examine the effectiveness of intervention programmes and determine the best intervention for schizophrenia and other severe mental illness, considering both vocational and non-vocational outcomes. Searching five databases – CINAHL, Medline via Ovid, Scopus, OT Seeker and Web of Science – a total of 3108 studies was identified; 24 met the selection criteria and were reviewed. Interventions were categorised into five major programmes of supported employment, integrated supported employment, vocational rehabilitation, cognitive intervention and virtual reality-based vocational training. Results Integrated supported employment was found to be the most effective approach for a vocational outcome. However, evidence concerning non-vocational outcomes of employment programmes and the use of cognitive training remains unclear. Conclusion Clinicians are advised to consider the needs and preferences of the client before selecting the best intervention programme. More research is needed to determine the applicability and the efficacy of intervention programmes.

Low Vocational Outcome Among People Diagnosed With Borderline Personality Disorder During First Admission to Mental Health Services in Denmark: A Nationwide 9-Year Register-Based Study

Earlier studies report that although people with borderline personality disorder (BPD) experience symptom reduction in the long term, they continue to have difficulties in work recovery. This nationwide 9-year register-based study (N = 67,075) investigated the long-term labor-market attachment of all individuals diagnosed with BPD during first admission to Danish mental health services in comparison with other psychiatric disorders. Controlling for baseline characteristics and co-occurring secondary psychiatric diagnoses, the BPD group had 32% lower odds (OR = 0.68; 95% CI [0.61, 0.76]) of being in work/under education after 9 years. Individuals diagnosed with BPD also showed more impairment in long-term vocational outcome than other personality disorders, and lower labor-market attachment than other psychiatric disorders except for schizophrenia, schizotypal and delusional disorders, and mental and behavioral disorders due to psychoactive substance use. Intervention programs addressing social psychiatric aspects of BPD in terms of work functioning is henceforth an important area for future research.

Influence of perfectionism on career decision self-efficacy and vocational outcome expectation among Asian American college students

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] In this study, Social Cognitive Career theory (SCCT; Lent, Brown, and Hackett, 1994; 2000) was the conceptual framework to understand Asian American students' career development process that incorporates cultural (person and contextual level). Due to the strong cultural emphasis on family obligations for achievement in academic and vocational realms, perfectionism is a salient construct among Asian American students (Chao and Tseng, 2002) and thus was included to explore its influence on Asian American students' career decision self-efficacy and vocational outcome expectations. The relationships among the study variables were explored through structural equation modeling analysis. As expected, a positive relationship between adaptive aspect of perfectionism and career variables (i.e., career decision self-efficacy and vocational outcome expectations) was found. This is in line with Asian culture in which there is the tendency to set high standards and strive to reach that standard to honor the family (Wang, 2010). Also, consistent with expectations, a negative association of maladaptive perfectionism on career decision self-efficacy and vocational outcome expectations was found. Career decision self-efficacy and vocational outcome expectations play a crucial role for successful career performance and outcomes (e.g., Gysbers, Heppner, and Johnson, 1998; Kim, 2000; Swanson and Woitke, 1997). Some studies in the past have focused on only the negative aspect of perfectionism (Blatt, 1995), limiting and invalidating its importance in certain cultures. However, considering these significant implications of career decision self-efficacy and vocational outcome expectations on career outcomes, the study's results suggest that it is important for career counselors and psychologists to intervene to increase adaptive perfectionism and lower maladaptive perfectionism. The research model was significant even after acculturation and enculturation were controlled, which was previously considered to be major constructs influencing Asian American students' career development. So the findings present a new aspect of understanding Asian American students' career development process, stressing the importance of perfectionism among this group of students. Suggestions for future research directions, clinical implications, and limitations are further provided.