Arbeitsrehabilitation psychisch kranker Menschen – ein Überblick über Erfolgsprädiktoren

Zusammenfassung

Anliegen Ziel dieser Arbeit ist es, einen Überblick über die wichtigsten prädiktiven Faktoren für eine erfolgreiche Wiedereingliederung psychisch Erkrankter in den Arbeitsprozess zu geben. Methode In einer Literaturrecherche über „pubmed” wurden die zwischen 1997 und 2007 zum Thema Arbeitsrehabilitation publizierten Arbeiten ausgehoben. Ergebnisse Die wichtigsten prädiktiven Faktoren stellen nach heutigem Wissensstand vorangegangene Beschäftigung und beobachtete Arbeitsleistung dar. Schlussfolgerungen Ziel zukünftiger Forschungsarbeit sollte es sein, neue Wege zu finden, um arbeitsrehabilitative Maßnahmen den speziellen Bedürfnissen der Patienten anzupassen.

Abstract

Objectives Unemployment has a strong negative impact on quality of life and on the further course of the disease of mentally disordered individuals. Therefore, vocational rehabilitation programmes are necessary to help people with mental disorders to obtain work. There is increasing scientific evidence concerning positive predictors for vocational integration. This paper intends to give an overview about established predictors for successful integration. Methods „Pubmed” was searched for studies on psychiatric vocational rehabilitation programmes published between 1997 and 2007, which had the focus on predictors of successful outcome. Results Some of the most important predictors are a better history of work integration and better work performance measured during psychiatric vocational rehabilitaton. Successful vocational integration is harder if negative symptoms or cognitive deficits are present. The impact of sociodemographic factors, diagnosis, motivation to work and social skills is discussed controversially. Conclusion Future research should be directed to design vocational rehabilitation programmes, which address the specific needs of psychiatric patients.

Schlüsselwörter

Arbeitsrehabilitation - berufliche Wiedereingliederung - Prädiktoren - psychische Erkrankung

Key words

vocational rehabilitation - mental illness - supported employment - predictors

Literatur

• 1 Mental health and work: Impact, issues and good practice. http:// http://www.who.int/mental_health/media/en/712.pdf
• 2 Crowther R E, Marshall M, Bond G R, Huxley P. Helping people with severe mental illness to obtain work: systematic review.  BMJ. 2001;  322 204-208
• 3 Gureje O, Herrman H, Harvey C, Morgan V, Jablensky A. The Australian National Survey of Psychotic Disorders: profile of psychosocial disability and its risk factors.  Psychol Med. 2002;  32 639-647
• 4 Mueser K T, Salyers M P, Mueser P R. A prospective analysis of work in schizophrenia.  Schizophr Bull. 2001;  27 281-296
• 5 McGurk S R, Mueser K T. Cognitive functioning, symptoms and work in supported employment: a review and heuristic model.  Schizophr Res. 2004;  70 147-173
• 6 Bond G R, Resnick S G, Drake R E, Xie H, McHugo G J, Bebout R R. Does competitive employment improve nonvocational outcomes for people with severe mental illness?.  J Consult Clin Psychol. 2001;  69 489-501
• 7 Mueser K T, Becker D R, Torrey W C, Xie H, Bond G R, Drake R E, Bradley J D. Work and nonvocational domains of functioning in persons with severe mental illness: A longitudinal analysis.  J Nerv Ment Dis. 1997;  185 419-426
• 8 Bell M D, Fiszdon J M, Greig T C, Bryson G J. Can older people with schizophrenia benefit from work rehabilitation?.  J Nerv Ment Dis. 2005;  193 293-301
• 9 Bryson G, Greig T, Lysaker P, Bell M D. Quality of life benefits of paid work activity in schizophrenia: a longitudinal analysis.  Schizophr Bull. 2002;  28 249-257
• 10 Holzner B, Kemmler G, Meise U. The impact of work-related rehabilitation on the quality of life of patients with schizophrenia.  Soc Psychiatry Psychiatr Epidemiol. 1998;  33 624-631
• 11 Ruesch P, Graf J, Meyer P C, Rössler W, Hell D. Occupation, social support and quality of life in persons with schizophrenic or affective disorders.  Soc Psychiatry Psychiatr Epidemiol. 2004;  39 686-694
• 12 Priebe S, Warner R, Hubschmid T, Eckle I. Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries.  Schizophr Bull. 1998;  24 469-477
• 13 Kager A, Lang A, Berghofer G, Henkel H, Schmitz M. The impact of work on quality of life for persons with severe mental illness.  Nervenheilkunde. 2000;  19 560-565
• 14 Marhawa S, Johnson S. Schizophrenia and employment.  Soc Psychiatry Psychiatr Epidemiol. 2004;  39 337-349
• 15 Lehmann A, Goldberg R, Dixon L, McNary S, Postrado L, Hackman A, McDonnell K. Improving employment outcomes for persons with severe mental illness.  Arch Gen Psychiatry. 2002;  59 165-172
• 16 Cook J A, Leff H S, Blyler C R, Gold P B, Goldberg R W, Mueser K T, Toprac M G, McFarlane W R, Shafer M S, Blankhertz L E, Dudek K, Razzano L A, Grey D D, Burke-Miller J. Results of a multisite randomized trial of supported employment interventions for individuals with severe mental illness.  Arch Gen Psychiatry. 2005;  62 505-512
• 17 Latimer E, Lecomte T, Becker D, Drake R, Duclos I, Piat M, Lahaie N, St-Pierre M-S, Therrien C, Xie H. Generalisability of the individual placement and support model of supported employment: results of a Canadian randomised controlled trial.  Br J Psychiatry. 2006;  189 65-73
• 18 Twamley E W, Padin D S, Bayne K S, Narvaez J M, Williams R E, Jeste D V. Work rehabilitation for middle-aged and older people with schizophrenia. A comparison of three approaches.  J Nerv Ment Dis. 2005;  193 596-601
• 19 Burns T, Catty J, Becker T. et al. for the EQOLISE Group . The effectiveness of supported employment for people with severe mental illness: a randomised controlled trial.  The Lancet. 2007;  370 1146-1152
• 20 Längle G, Bayer W, Köster M, Salize H J, Höhl W, Machleidt W, Wiedl K H, Buchkremer G. Unterscheiden sich die Effekte stationärer Arbeits- und ergotherapeutischer Maßnahmen? Ergebnisse einer kontrollierten Multizenterstudie des Kompetenznetzes Schizophrenie.  Psychiat Prax. 2006;  33 34-41
• 21 Salize H J, Schuh C, Krause M, Reichenbacher M, Stamm K, Längle G. und die KN-Schizophrenie-Projektgruppe Arbeitsrehabilitation . Senken arbeitsrehabilitative Maßnahmen während stationärpsychiatrischer Behandlung langfristig die Versorgungskosten von Patienten mit Schizophrenie? Ergebnisse einer kontrollierten Multizenterstudie.  Psychiat Prax. 2007;  34 246-248
• 22 Bryson G, Bell M D. Initial and final work performance in schizophrenia: cognitive and symptom predictors.  J Nerv Ment Dis. 2003;  191 87-92
• 23 Evans J D, Bond G R, Meyer P S, Kim H W, Lysaker P H, Gibson P J, Tunis S. Cognitive and clinical predictors of success in vocational rehabilitation in schizophrenia.  Schizophr Res. 2004;  70 331-342
• 24 McGurk S R, Mueser K T, Harvey P D, LaPuglia R, Marder J. Cognitive and symptom predictors of work outcomes for clients with schizophrenia in supported employment.  Psychiatr Serv. 2003;  54 1129-1134
• 25 Richter A, Blaha L, Groß W, Schreiber W. Prädiktion des beruflichen Erfolges bei schizophren Erkrankten.  Psychiat Prax. 2004;  31, Supplement 1 S35-S37
• 26 Hoffmann H, Kupper Z, Zbinden M, Hirsbrunner H P. Predicting vocational functioning and outcome in schizophrenia outpatients attending a vocational rehabilitation program.  Soc Psychiatry Psychiatr Epidemiol. 2003;  38 76-82
• 27 Suslow T, Schonauer K, Ormann P, Eikelmann B, Reker T. Prediction of work performance by clinical symptoms and cognitive skills in schizophrenic outpatients.  J Nerv Ment Dis. 2000;  188 116-118
• 28 Hoffmann H, Kupper Z, Kunz B. Hopelessness and its impact on rehabilitation outcome in schizophrenia – an exploratory study.  Schizophr Res. 2000;  43 147 -158
• 29 Fabian E S. Supported employment and the quality of life: Does a job make a difference?.  Rehabil Counsel Bull. 1992;  36 84-97
• 30 Jacobs H E, Wissusik D, Collier R, Stackman D, Burkeman D. Correlations between disabilities and vocational outcome.  Hosp Community Psychiatry. 1992;  43 365-369
• 31 Mueser K T, Becker D R, Torrey W C, Xie H, Bond G R, Drake R E, Bradley J D. Work and nonvocational domains of functioning in persons with severe mental illness: A longitudinal analysis.  J Nerv Ment Dis. 1997;  185 419-426
• 32 Galvao A, Watzke S, Gawlik B, Hühne M, Brieger P. Vorhersage der Verbesserung des beruflichen Status chronisch Kranker nach rehabilitativen bzw. integrativen Maßnahmen.  Rehabilitation. 2005;  44 208-214
• 33 Rogers E S, Anthony W A, Cohen M, Davies R. Prediction of vocational outcome based on clinical and demographic indicators among vocationally ready clients.  Community Ment Health J. 1997;  33 99-112
• 34 Meyer P, Bond G, Tunis S, McCoy L. Comparison between the effects of atypical and traditional antipsychotics on work status for clients in a psychiatric rehabilitation program.  J Clin Psychiatry. 2002;  63 108-116
• 35 Bond G R, Kim H W, Meyer P S, Gibson P J, Tunis S, Evans J D, Lysaker P, McCoy M L, Dincin J, Xie H. Response to vocational rehabilitation during treatment with first- or second-generation antipsychotics.  Psychiatr Serv. 2004;  55 59-66
• 36 Watzke S, Galvao A, Gawlik B, Hühne M, Brieger P. Ausprägung und Veränderung der Arbeitsfähigkeiten psychisch kranker Menschen in der beruflichen Rehabilitation.  Psychiat Prax. 2005;  32 292-298
• 37 Rogers E S, Anthony W A, Toole J, Brown M A. Vocational outcomes following psychosocial rehabilitation.  J Vocational Rehabilitation. 1991;  1 21-29
• 38 Cook J A, Razzano L. Discriminant function analysis of competitive employment outcomes in a transitional employment program for persons with severe mental illness.  J Vocational Rehabilitation. 1995;  5 127-139
• 39 Frühwald S, Bühler B, Grasl R, Gebetsberger M, Matschnig T, König F, Frottier P. (Irr-)wege in die Arbeitswelt – Langzeitergebnisse arbeitsrehabilitativer Einrichtungen für psychisch Kranke der Caritas St. Pölten.  Neuropsychiatrie. 2006;  20 250-256
• 40 Michon H WC, van Weeghel J, Kroon H, Schene A H. Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes – a systematic review.  Soc Psychiatry Psychiatr Epidemiol. 2005;  40 408-416
• 41 Anthony W A. Characteristics of people with psychiatric disabilities that are predictive of entry into the rehabilitation process and successful employment.  Psychosocial Rehabilitation Journal. 1994;  17 3-13
• 42 Reker T, Eikelmann B. Prädiktoren einer erfolgreichen beruflichen Eingliederung.  Psychiat Prax. 1999;  26 218 - 223
• 43 Hoffmann H, Kupper Z. Prädiktive Faktoren einer erfolgreichen beruflichen Wiedereingliederung von schizophrenen Patienten.  Psychiat Prax. 2003;  30 312-317
• 44 Richter A, Groß W, Schreiber W. Prädiktion des beruflichen Erfolges bei schizophren Erkrankten: 36 Monate Follow-up.  Psychiat Prax. 2007;  34, Supplement 1 S153-S154
• 45 Gold J M, Goldberg R W, McNary S W, Dixon L B, Lehman A F. Cognitive correlates of job tenure among patients with severe mental illness.  Am J Psychiatry. 2002;  159 1395-1402
• 46 Bell M D, Bryson G. Work rehabilitation in schizophrenia: does cognitive impairment limit improvement?.  Schizophr Bull. 2001;  27 269-279
• 47 Lysaker P, Bell M, Beam-Goulet J. Wisconsin card sorting test and work performance in schizophrenia.  Psychiatr Res. 1995;  56 45-51
• 48 Mecklenburg H. Zwölf Thesen für eine langfristig erfolgreiche berufliche Integration psychisch Kranker und Behinderter.  Psychiat Prax. 1999;  26 227-232
• 49 Reker T. Krankheits- und Rehabilitationsverläufe schizophrener Patienten in ambulanter Arbeitstherapie.  Nervenarzt. 1998;  69 210-218
• 50 Davis L W, Nees M A, Hunter N L, Lysaker P H. Brief reports: hopelessness as a predictor of work functioning among patients with schizophrenia.  Psychiatr Serv. 2004;  55 434-436
• 51 Vauth R, Rüsch N, Wirtz M, Corrigan P W. Does social cognition influence the relation between neurocognitive deficits and vocational functioning in schizophrenia?.  Psychiatr Res. 2004;  128 155-165
• 52 Evert H, Harvey C, Trauer T, Herrman H. The relationship between social networks and occupational and self-care functioning in people with psychosis.  Soc Psychiatry Psychiatr Epidemiol. 2003;  38 180-188
• 53 Watzke S, Galvao A, Gawlik B, Hühne M, Brieger P. Maßnahmenabbrecher in der beruflichen Rehabilitation psychisch kranker Menschen.  Psychiat Prax. 2006;  33 124-131
• 54 Lysaker P, Bond G, Davis L, Bryson G, Bell M. Enhanced cognitive-behavioural therapy for vocational rehabilitation in schizophrenia: effects on hope and work.  J Rehabil Res Dev. 2005;  42 673-682
• 55 McGurk S, Mueser K, Feldman K, Wolfe R, Pascaris A. Cognitive training for supported employment: 2 – 3 year outcomes of a randomized controlled trial.  Am J Psychiatry. 2007;  164 377-379
• 56 Rose V, Perz J. Is CBT useful in vocational rehabilitation for people with a psychiatric disability?.  Psychiatr Rehabil J. 2005;  29 56-58
• 57 Vauth R, Corrigan P W, Clauss M, Dietl M, Dreher-Rudolph M, Stieglitz R D, Vater R. Cognitive Strategies versus self-management skills as adjunct to vocational rehabilitation.  Schizophr Bull. 2005;  31 55-66
• 58 Wexler B E, Bell M D. Cognitive remediation and vocational rehabilitation for schizophrenia.  Schizophr Bull. 2005;  31 931-941
• 59 Hoffmann H. Berufliche Rehabilitation. In: Rössler W Psychiatrische Rehabilitation. Heidelberg; Springer 2004: 333-346
• 60 Rössler W. Perspektiven der psychiatrischen Rehabilitation.  Psychiatrie & Psychotherapie. 2007;  3 3-8
• 61 Wiedl K, Uhlhorn S, Jöns K. Das Osnabrücker Arbeitsfähigkeitenprofil (O-AFP) für psychiatrisch erkrankte Personen: Konzept, Entwicklung und Erprobung bei schizophrenen Patienten.  Rehabilitation. 2004;  43 368-374