S223. DETERMINANTS OF SUSTAINED UNEMPLOYMENT IN FORMERLY EMPLOYED SCHIZOPHRENIA PATIENTS
Authors: Fundora-Trujillo Cynthia , Cruz Maria , Barone Katelyn , Penn David L , Pinkham Amy , Harvey Philip 
Published: May 2020

Abstract

Background
Vocational drift, or the suggestion that severe mental illness leads to reductions in occupational attainment, has been repeatedly observed in schizophrenia. Neurocognition, social functioning, education, environment, and previous work experience have been implicated in patients’ ability to acquire and maintain a job. Interestingly, some patients with successful prior work histories can develop chronic unemployment. In this study, we analyzed a sample of schizophrenic individuals with varying histories of obtaining and sustaining employment to examine vocational drift through the lens of vocational deterioration. We hypothesized that 1) social cognitive variables would be more impaired in patients with a long duration of unemployment and 2) neurocognitive deficits would be more prominent in patients who were never employed.

Methods
396 patients between 18 and 70 years old with a diagnosis of Schizophrenia, Schizoaffective Disorder, or First Episode Spectrum Disorder were included in this analysis. Measures included comprehensive clinical, neurocognitive, social cognitive, and functional assessments. Samples were divided into groups based on their employment history.
Although our original sample included currently employed patients, the following groups were examined as a function of vocational drift: a) Never (n=150), individuals who have never had a job and b) Formerly employed (n=138), individuals who had a job for at least two years in the past but are currently unemployed. Among unemployed patients, we identified those with Short (less than 2 years; n=65), Intermediate (2 to 5 years; n=87), and Extended (more than 5 years; n=136) unemployment.

Results
In the overall comparison of Formerly employed patients, those with Short and Intermediate duration of unemployment did not differ from each other on any variables and performed better than Extended duration unemployment patients on measures of premorbid intelligence (WRAT, p&lt;.01), processing speed (Symbol coding, p&lt;.01), emotion recognition (BLERT, p&lt;.01 and ER-40, p&lt;.01), theory of mind (Hinting test, p&lt;.05) and hostile cognitive bias (AIHQ Blame, p&lt;.01). Interestingly, patients with Extended unemployment had less depression (BDI total, p&lt;.01) compared to patients who Never worked. The Extended unemployment patients performed worse than the Never employed patients on premorbid intelligence (WRAT, p&lt;.01), processing speed (Symbol coding, p&lt;.05), emotion recognition (BLERT, p&lt;.01 and ER-40, p&lt;.01), theory of mind (Hinting test, p&lt;.05), social inference (TASIT, p&lt;.01), hostile cognitive bias (AIHQ Blame, p&lt;.01), and had higher clinical ratings on PANSS Blunted affect (P&lt;.01) and Poor Rapport (p&lt;.01).

Discussion
The development of long-term unemployment in patients with schizophrenia is associated with multiple neurocognitive and social cognitive deficits, particularly when compared to patients who have never been employed. These deficits were also notable when compared to patients with a shorter duration of unemployment. It is not possible to determine if these long-term unemployed patients always exhibited these deficits, suggesting additional support for vocational drift among patients with schizophrenia. The possible deterioration in neurocognitive and social cognitive performance over time may be driving the development of long-term unemployment in previously employed patients, who in many ways, underperformed compared to patients who had never worked.