Symptomatic remission affects employment outcomes in schizophrenia patients

San-Ping Wang,Jung-Der Wang,Bo-Jian Wu,Jer-Hao Chang,Hsiao-Ju Sun,Tso-Jen Wang

doi:10.1186/s12888-020-02630-z

Abstract

BackgroundRemission criteria were proposed by Andreasen et al. for classifying patients with schizophrenia according to the severity of psychopathology. Up to the present time, there have been no cohort studies exploring the association between remission status and employment outcomes in patients with schizophrenia. The study explored whether symptomatic remission is significantly associated with employment outcomes in a two-year longitudinal study.MethodsAll 525 stable patients with schizophrenia in the therapeutic community of a public mental hospital in Taiwan were recruited between 2013 and 2015. Employment outcomes, defined as the cumulative on-the-job duration (months/per year) and income (new Taiwan dollars, NT$/per year), were investigated at the end of 1- and 2-year follow-up periods after enrollment. For repeated measurements, linear mixed models were constructed to examine the association between symptomatic remission and employment outcomes after controlling for potential confounding variables including age, sex, education, type and daily dose of antipsychotics, cognitive function, psychosocial functioning and initial employment type.ResultsThe average age of patients was 51.8 years, and 65.3% were males. Among them, 124 patients (23.6%, 124/525) met the remission criteria at baseline. The linear mixed-model analysis showed that patients who had symptomatic remission were employed 0.8 of a month longer (p = 0.029) and earned NT$3250 more (p = 0.001) within 1 year than those who did not show symptomatic remission.ConclusionOur study suggests that assessing symptomatic remission is a useful part of monitoring treatment effectiveness for schizophrenia, and all strategies targeting the bio-psycho-social domains to attain symptomatic remission are paramount to maintaining favorable employment outcomes.

Highlights

Remission criteria were proposed by Andreasen et al for classifying patients with schizophrenia according to the severity of psychopathology
At the baseline, 525 residents in the therapeutic community of Yuli Hospital, Ministry of Health and Welfare, between January 2013 and December 2015 participated in this study
We found that patients recruited in the therapeutic community exhibited an association between symptomatic remission and employment outcomes

Summary

Introduction

Remission criteria were proposed by Andreasen et al for classifying patients with schizophrenia according to the severity of psychopathology. Up to the present time, there have been no cohort studies exploring the association between remission status and employment outcomes in patients with schizophrenia. The study explored whether symptomatic remission is significantly associated with employment outcomes in a two-year longitudinal study. Andreasen and colleagues initially defined symptomatic remission in schizophrenia, published by the Remission in Schizophrenia Working Group (RSWG) in 2005, as patients having eight core symptoms of a low severity level over a period of at least 6 months, and as patients with either none or mild symptoms at first episode who seem more likely to develop symptomatic remission [11]. It is suggested that researchers focus more on outcomes based on practical disabling experiences and the realworld functioning of patients instead of engaging in excessive reliance on global measures of psychopathology and disability [21]

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