Occupational outcome of patients with schizophrenia after first request for disability status: A 2-year follow-up study

Objective. - To assess occupational outcome of persons with schizophrenia over the 2 years following the first request of disability status. Methods. - This study was carried out in collaboration with the Commission Technique d'Orientation et de Reclassement Professionnel (COTOREP) (technical commission for occupational guidance and rehabilitation of the disabled) de la Gironde (Bordeaux region, South Western France). Persons with schizophrenia or schizoaffective disorder requesting for the first time in 2006 a disability allowance or the status of disabled worker were assessed using a standardized questionnaire collecting data on clinical, occupational and income history. Information on occupational outcome over the 2 years after the first request was collected at the end of the follow-up using multiple sources of information. We used a broad definition of work, including moonlighting and episodic activities (baby-sitting or grape-harvesting), as well as study periods. Results. - Of the 121 patients included at baseline, direct or indirect information was available for 108 (90%) at the 24-month assessment. Persons lost to follow-up were less likely to have worked before first request of disability status compared to persons with information available at the end of the follow-up, but did not differ regarding the other characteristics. Nearly half of the persons (41.7%) had worked over the follow-up, irrespective of the type and duration of the occupation. The working periods were of short duration (median duration 14.5 days, interquartile range 6.5-47.5) and most (98%) were done in low-qualified jobs. Nearly half of the persons reported that they had benefitted from support for starting or returning to work, mainly from recruitment agencies specialized in supporting disabled workers. Persons with the status of disabled worker (Reconnaissance de la qualite de travailleur handicape) (RTH) were more likely to have worked over the follow-up period (66.7% vs 33.3%; OR = 3.9; 95%IC 1.3-11.3; p < 0.01) as well as persons who had benefitted from institutional support (61.1% vs 38.9%; OR = 3.0; 95%IC 1.2-7.8; p = 0.02). However, a noteworthy result was that most jobs were obtained by the patient's personal effort. Nearly one out of four patients (23.2%) was involved in vocational training over the follow-up period. Conclusion. - This prospective study demonstrates that half of persons with schizophrenia who benefit from the disabled status remain actively engaged in vocational rehabilitation. Hence, giving access to disability status does not act as a disincentive regarding the return or access to work. However, the benefit of being kept involved in vocational rehabilitation has to be weighted against the fact that most patients only obtained low-qualified jobs of short-duration. This precarious situation may be stressful and may have a deleterious impact regarding self-esteem. (C) L'Encephale, Paris, 2010.