Abstract
PurposeIndividuals with schizophrenia have been reported to have low employment rates. We examined the associations of schizophrenia with employment, income, and status of cohabitation from a work life course perspective.MethodsNationwide cohort study including all individuals (n = 2,390,127) born in Denmark between 1955 and 1991, who were alive at their 25th birthday. Diagnosis of schizophrenia (yes/no) between ages 15 and 25 was used as an exposure. Employment status, annual wage or self-employment earnings, level of education, and cohabitant status from the age of 25–61 (years 1980–2016) were used as outcomes.ResultsSchizophrenia diagnosis between ages 15 and 25 (n = 9448) was associated with higher odds of not being employed (at the age of 30: OR 39.4, 95% CI 36.5–42.6), having no secondary or higher education (7.4, 7.0–7.8), and living alone (7.6, 7.2–8.1). These odds ratios were two-to-three times lower and decreasing over time for those individuals who did not receive treatment in a psychiatric inpatient or outpatient clinic for schizophrenia after the age of 25. Between ages 25–61, individuals with schizophrenia have cumulative earning of $224,000, which is 14% of the amount that the individuals who have not been diagnosed with schizophrenia earn.ConclusionsIndividuals with schizophrenia are at high risk of being outside the labour market and living alone throughout their entire life, resulting in an enormous societal loss in earnings. Individuals with less chronic course of schizophrenia had a gradual but substantial improvement throughout their work life.
Highlights
Schizophrenia is a poorly understood group of disorders, with reduced life expectancy from 10 to years [1], affecting globally over million individuals [2]
Between ages 15 and 25, 9448 individuals were diagnosed with schizophrenia and 20,633 participants were diagnosed with schizophrenia after the age of 25
Descriptive statistics, number of participants, and labour market outcomes, for the three different groups are reported in Online Appendix Tables 1 and 2, respectively
Summary
Schizophrenia is a poorly understood group of disorders, with reduced life expectancy from 10 to years [1], affecting globally over million individuals [2]. The societal burden of schizophrenia is substantial [4,5,6]; it has been estimated that the total cost of schizophrenia in the USA at 2013 was around $150 billion [7], and in England, it was around £20 billion in 2010/2011 [8] From these costs, indirect costs attributed to unemployment have been shown to be largest components of the total economic burden of schizophrenia [5], indicating that schizophrenia can lead to occupational and social exclusion [9]. Indirect costs attributed to unemployment have been shown to be largest components of the total economic burden of schizophrenia [5], indicating that schizophrenia can lead to occupational and social exclusion [9] It remains unclear what are the prospects of individuals with schizophrenia in terms of occupational (i.e., employment, income, and education) and social inclusion (i.e., cohabitation) over the work life course. Only around 14% of individuals with schizophrenia will achieve both clinical and functional recovery [18], supported employment has been shown to be effective at placing individuals with schizophrenia in competitive employment across the world [19, 20]
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