Predictors of work and education among people with severe mental illness who participated in the Danish individual placement and support study: findings from a randomized clinical trial.

People with severe mental illness experience disproportionately high rates of unemployment. Nonetheless, a substantial amount of research has demonstrated vocational benefits of the Individual Placement and Support (IPS) model and IPS supplemented with cognitive remediation (IPSE). The present study sought to examine demographic and clinical predictors of employment or education among people with severe mental illness and to investigate if IPS or IPSE can compensate for risk factors for unemployment. Seven hundred twenty participants were randomly assigned to IPS, IPSE or Service as Usual. During the 18-month follow-up period participants in the two experimental groups obtained significantly more work or education. A series of univariate and multiple logistic regression analyses were conducted to assess the predictive power of demographic and clinical factors for the total population and for the three groups individually. The strongest predictor for vocational recovery, besides treatment allocation, was previous work history (OR = 1.78; 95% CI = 1.28-2.47). Men had a lower probability for vocational recovery compared to women (OR = 0.71; 95% CI = 0.50-0.99) and higher age was also negatively associated with work or education (OR = 0.79; 95% CI = 0.67-0.93). Moreover, vocational recovery was predicted by higher readiness for change, measured on the readiness for change scale (OR = 1.42; 95% CI = 1.19-1.70). Participation in IPS or IPSE could not compensate for negative risk factors such as low cognitive function or negative symptoms. In a multiple logistic regression analysis age, previous work history and motivation for change were statistically significant predictors of obtaining work or education among people with severe mental illness who participated in the Danish IPS trial.

Christensen TN ，Wallstrøm IG ，Bojesen AB ，Nordentoft M ，Eplov LF ... -  《-》

Effects of Individual Placement and Support Supplemented With Cognitive Remediation and Work-Focused Social Skills Training for People With Severe Mental Illness: A Randomized Clinical Trial.

Christensen TN ，Wallstrøm IG ，Stenager E ，Bojesen AB ，Gluud C ，Nordentoft M ，Eplov LF ... -  《-》

Trajectories of Vocational Recovery Among Persons with Severe Mental Illness Participating in a Randomized Three-Group Superiority Trial of Individual Placement and Support (IPS) in Denmark.

To investigate longitudinal trajectories of vocational recovery (VR) among individuals with severe mental illness (SMI) who participated in the Danish Individual Placement and Support (IPS) trial, and whether the IPS intervention, socio-demographic and disease-specific characteristics predicted trajectory membership. In an observational study design, we used previously collected data from the Danish IPS trial (N = 720). VR was defined as 'weeks in competitive employment or education in the past 6 months and was measured after 0.5, 1, 1.5, 2 and 2.5 years, using data from the Danish Register for Evaluation of Marginalization (DREAM) database. Latent growth mixture modelling in Mplus statistical software (version 7) was applied to identify trajectories of VR. Multinomial logistic regression analyses were used to estimate predictors for trajectory membership. Four trajectories were identified: 'Low VR' (61.3%), 'Low Increasing VR (8.2%), 'Increasing Decreasing VR' (7.2%) and 'High VR' (23.4%). Receiving the IPS intervention increased odds of membership in 'High VR' compared to 'Low VR' (OR = 2.18; 95% CI 1.37-3.48) and so did higher education (OR = 2.25; 95% CI 1.39-3.64), higher cognitive function (OR = 1.17; 95% CI 1.02-1.35), higher motivation to change (OR = 1.04; 95% CI 1.02-1.05) and previous work history (OR = 1.64; 95% CI 1.09-2.46). Higher age decreased odds of membership in the 'High VR' (OR = 0.95; 95% CI 0.93-0.98) compared to 'Low VR'. There was high heterogeneity in the identified VR trajectories, despite that all participants expressed a desire for work and education at baseline. Improvements of the IPS intervention are needed to support specific groups in achieving and retaining employment.

Poulsen CH ，Christensen TN ，Madsen T ，Nordentoft M ，Eplov LF ... -  《-》

Individual Placement and Support supplemented with cognitive remediation and work-related social skills training in Denmark: study protocol for a randomized controlled trial.

Christensen TN ，Nielsen IG ，Stenager E ，Morthorst BR ，Lindschou J ，Nordentoft M ，Eplov LF ... -  《Trials》

30-Month Follow-Up of Individual Placement and Support (IPS) and Cognitive Remediation for People with Severe Mental Illness: Results from a Randomized Clinical Trial.

The individual placement and support (IPS) model for persons with severe mental illness has proven to be more effective than traditional vocational approaches in improving competitive work over 18 months. In this study, the longer-term effects of IPS over 30 months were investigated in a Danish setting. In a randomized clinical trial, we compared the effects of IPS, IPS enhanced with cognitive remediation and work-related social skills training (IPSE), and service as usual (SAU). At three locations in Denmark, 720 patients with serious mental illnesses were randomly assigned to the three groups. Competitive employment, education, and hospital admissions were tracked for 30 months using Danish national registers. The beneficial effects of IPS on competitive employment and education at the 18-month follow-up were sustained over the 30-month follow-up period. Participants receiving IPS or IPSE were more likely to obtain competitive employment or education than those who received service as usual (IPS 65%, IPSE 65%, SAU 53%, p = 0.006), and they worked on average more weeks competitively (IPS 25 weeks, IPSE 21 weeks, SAU 17 weeks; IPS vs. SAU p = 0.004 and IPSE vs. SAU p = 0.007). Moreover, participants in the two IPS groups had fewer outpatient visits during the 30-month follow-up. However, this was only statistically significant when comparing IPSE with SAU p = 0.017. In conclusion, IPS and IPS enhanced with cognitive remediation and work-related skills training demonstrated that the vocational effects of the interventions are retrained over 30 months in a Danish context.

Christensen TN ，Wallstrøm IG ，Stenager E ，Hellström L ，Bojesen AB ，Nordentoft M ，Eplov LF ... -  《-》