Web-Based Cognitive Remediation Improves Supported Employment Outcomes in Severe Mental Illness: Randomized Controlled Trial.

Chris Walker,William Gye,Anthony WF Harris,Tanya Kosic,Jean Xu,Antoinette Redoblado Hodge

doi:10.2196/mental.6982

Abstract

BackgroundFinding work is a top priority for most people; however, this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. Supported employment (SE) programs aimed at returning people with a severe mental illness to work are successful; however, they still leave a significant number of people with severe mental illness unemployed. Cognitive deficits are commonly found in SMI and are a powerful predictor of poor outcome. Fortunately, these deficits are amenable to treatment with cognitive remediation therapy (CRT) that significantly improves cognition in SMI. CRT combined with SE significantly increases the likelihood of individuals with severe mental illness obtaining and staying in work. However, the availability of CRT is limited in many settings.ObjectiveThe aim of this study was to examine whether Web-based CRT combined with a SE program can improve the rate return to work of people with severe mental illness.MethodsA total of 86 people with severe mental illness (mean age 39.6 years; male: n=55) who were unemployed and who had joined a SE program were randomized to either a Web-based CRT program (CogRem) or an Internet-based control condition (WebInfo). Primary outcome measured was hours worked over 6 months post treatment.ResultsAt 6 months, those participants randomized to CogRem had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition. No change was observed in cognition.ConclusionsThis study corroborates other work that has found a synergistic effect of combining CRT with a SE program and extends this to the use of Web-based CRT. The lack of any improvement in cognition obscures the mechanism by which an improved wage outcome for participants randomized to the active treatment was achieved. However, the study substantially lowers the barrier to the deployment of CRT with other psychosocial interventions for severe mental illness.Trial RegistrationAustralian and New Zealand Clinical Trials Registry (ANZCTR) 12611000849998; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=12611000849998&isBasic=True (Archived by WebCite at http://www.webcitation.org/6sMKwpeos)

Highlights

Functional recovery in people with a severe mental illness such as schizophrenia remains poor with high rates of dependence upon government benefits and significant difficulty with social isolation
At 6 months, those participants randomized to cognitive remediation plus supported employment (CogRem) had worked significantly more hours (P=.01) and had earned significantly more money (P=.03) than those participants randomized to the WebInfo control condition
This study corroborates other work that has found a synergistic effect of combining cognitive remediation therapy (CRT) with a Supported employment (SE) program and extends this to the use of Web-based CRT

Summary

Introduction

Functional recovery in people with a severe mental illness such as schizophrenia remains poor with high rates of dependence upon government benefits and significant difficulty with social isolation. In Australia, only 22.4% of people with a psychotic disorder were in either part or full time employment, and this employment rate had not changed in a decade [3] despite paid employment being a priority for many [4] This failure to return to competitive employment ensures continued poverty and marginalization for most people with a severe mental illness and shuts them out of important sources of socialization and integration with the rest of the community. Finding work is a top priority for most people; this goal remains out of reach for the majority of individuals with a severe mental illness (SMI) who remain on benefits or are unemployed. The availability of CRT is limited in many settings

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Conclusion