Zusammenfassung
Anliegen: Selbst mithilfe umfassender Wiedereingliederungsprogramme bleibt die berufliche Rehabilitation von Patienten mit chronischer Schizophrenie ein sehr hoch gestecktes Ziel. Ein vertieftes und dem heutigen Stand entsprechendes Wissen über die prädiktiven Faktoren einer erfolgreichen Wiedereingliederung ist deshalb unabdingbar. Anliegen der vorliegenden Untersuchung war es, unter Minimierung des Einflusses der verwendeten Instrumente, Faktoren zu ermitteln, die den Wiedereingliederungserfolg am besten voraussagen können. Methode: In einer Stichprobe von 76 Patienten mit chronischer Schizophrenie wurden mittels einer Faktorenanalyse aus 32 Variablen 10 für das Funktionieren am Arbeitsplatz relevante Faktoren ermittelt. In einem zweiten Schritt wurde der prädiktive Wert dieser Faktoren für den Wiedereingliederungserfolg mittels logistischer Regression ermittelt. Ergebnisse: Erfolgreich waren diejenigen Teilnehmenden, die vor und während der zweiwöchigen Abklärungsphase ein gutes Arbeitsverhalten zeigten, keine Defizite im Sozialverhalten und keine depressiv-resignativen Bewältigungsstrategien aufwiesen. Krankheitssymptome und neurokognitive Defizite waren dagegen von untergeordneter Bedeutung. Schlussfolgerungen: Die Resultate unseres faktoranalytischen Ansatzes bestätigen frühere Ergebnisse, dass das Arbeitsverhalten in einem geschützten Rahmen sowie soziale Kompetenz die besten Prädiktoren einer erfolgreichen beruflichen Wiedereingliederung sind. Zudem bekräftigen sie die Notwendigkeit, Therapieprogramme zu entwickeln, die Zuversicht und Selbstvertrauen der Patienten fördern.
Abstract
Objective: Vocational re-integration of patients with chronic schizophrenia remains even with the help of comprehensive integration programs a very ambitious aim. Therefore, a profound and up-to-date knowledge of vocational outcome predictors is imperative. The objective of the present study was, while minimizing the influence of the instruments used, to generate factors, which predict best the re-integration outcome. Method: In a sample of 76 chronic schizophrenia patients ten relevant factors were derived from a factor analysis including 32 variables. In a second step the predictive value of these ten factors centering on vocational outcome were tested by logistic regression analysis. Results: Participants who had a successful outcome showed a good vocational capacity before and during the two-week assessment phase, had no social deficits and no depressive-resignative coping strategies. Schizophrenia symptoms and cognitive deficits, however, were of minor relevance. Conclusions: The results of our factor-analytic approach confirm earlier findings that vocational functioning observed in a sheltered setting and social competence are the best predictors for successful vocational rehabilitation. Moreover, they serve to substantiate the necessity of developing therapeutic programs that enhance patients' hopefulness and self-confidence.
Literatur
-
1
Fabian E.
Longitudinal outcomes in supported employment: A survival analysis.
Rehabilitation Psychology.
1992;
37
23-35
-
2
Jacobs H E, Wissusik D, Collier R, Stackman D, Burkeman D.
Correlations between psychiatric disabilities and vocational outcome.
Hospital and Community Psychiatry.
1992;
43
365-369
-
3
Beiser M, Bean G, Erickson D, Zhang J, Iacono W, Rector N.
Biological and psychological predictors of job performance following a first episode psychosis.
American Journal of Psychiatry.
1994;
151
857-863
-
4
Anthony W A, Rogers E S, Cohen M, Davies R R.
Relationships between psychiatric symptomatology, work skills and future vocational performance.
Psychiatric Services.
1995;
46
353-358
-
5
Harding C M, Brooks G W, Ashikaga R, Strauss J S, Breier A.
The Vermont longitudinal study of persons with severe mental illness. I. Methodology, study sample, and overall status 32 years later.
American Journal of Psychiatry.
1987;
151
718-726
-
6
McGlashan T.
A selective review of recent North American long-term follow-up studies of schizophrenia.
Schizophrenia Bulletin.
1988;
14
515-542
-
7
Breier A, Schreiber J, Dyer J, Pickar D.
National Institute of Mental Health longitudinal study of chronic schizophrenia.
Archives of General Psychiatry.
1991;
48
239-246
-
8
Harrow M, Sand J, Silverstein M, Goldberg J.
Course and outcome for schizophrenia versus other psychotic patients: A longitudinal study.
Schizophrenia Bulletin.
1997;
23
287-303
-
9
Bellack A S, Gold J M, Buchanan R W.
Cognitive rehabilitation for schizophrenia: Problems, prospects, and strategies.
Schizophrenia Bulletin.
1999;
25
257-274
-
10 Crowther R, Marshall M, Bond G, Huxley P. Vocational rehabilitation for people with severe mental illness (Cochrane Review). In: The Chochrane Library, Issue 3. Oxford; Update Software 2000
-
11
Cook J A, Razzano L.
Vocational rehabilitation for persons with schizophrenia: Recent research and implications for practice.
Schizophrenia Bulletin.
2000;
26
87-103
-
12
Hoffmann H, Kupper Z.
Relationships between social competence, psychopathology and work performance and their predictive value for vocational rehabilitation of schizophrenic outpatients.
Schizophrenia Research.
1997;
23
69-79
-
13
Hoffmann H, Kupper Z, Kunz B.
Predicting schizophrenic outpatients behavior by symptomatology and social skills.
Journal of Nervous and Mental Disease.
1998;
186
214-222
-
14
Hoffmann H, Kupper Z, Kunz B.
The impact of hopelessness on rehabilitation outcome in schizophrenia.
Schizophrenia Research.
2000;
43
147-158
-
15
Hoffmann H, Kupper Z, Zbinden M, Hirsbrunner H-P.
Predicting the vocational capacity of schizophrenia outpatients enrolled in a vocational rehabilitation program.
Social Psychiatry and Psychiatric Epidemiology.
2003;
38
76-82
-
16 Spaniol L, Koehler M. The Experience of Recovery. Center for Psychiatric Rehabilitation. Boston; University 1994
-
17
Hoffmann H, Kupper Z.
Facilitators of psychosocial recovery from schizophrenia.
International Review of Psychiatry.
2002;
14
293-302
-
18
Liberman R P, Kopelowicz A, Gutkind D, Ventura J.
Operational criteria and factors related to recovery from schizophrenia.
International Review of Psychiatry.
2002;
14
256-272
-
19
Anthony W A, Jansen M A.
Predicting the vocational capacity of the chronically mentally ill. Research and policy implications.
American Psychologist.
1984;
39
537-544
-
20
Hoffmann H.
Berufliche Integration in den allgemeinen Arbeitsmarkt - Ein realistisches Ziel für chronisch psychisch Kranke?.
Psychiat Prax.
1999;
26
211-217
-
21 APA (American Psychiatric Association) .Diagnostic and statistical manual of mental disorders - DSM IV (4th ed.). Washington; American Psychiatric Association 1994
-
22 Kay S R, Opler L A, Fishbein A. Positive and Negative Syndrome Scale (PANSS) Rating Manual. Toronto; Multihealth Systems 1992
-
23 Wechsler D. Die Messung der Intelligenz Erwachsener: Textband zum Hamburg-Wechsler-Intelligenztest für Erwachsene (HAWIE). Bern; Huber 1964
-
24 Benton A L. Der Benton-Test: Handbuch. Bern; Hans Huber 1974
-
25 Brickenkamp R. Aufmerksamkeits-Belastungs-Test d2. Göttingen; Hogrefe 1981
-
26 Honigfeld G, Gillis R D, Klett C J. Nurses Observation Scale for Inpatient Evaluation (NOSIE-30). Skala zur Beobachtung stationärer Patienten durch das Pflegepersonal. In: Collegium Internationale Psychiatriae Scalarum (CIPS) (Hrsg) Internationale Skalen für Psychiatrie. Weinheim; Beltz 1986
-
27
Hoffmann H, Kupper Z.
Patient dynamics in early stages of vocational rehabilitation - A pilot study.
Comprehensive Psychiatry.
1996;
37
216-221
-
28
Ciompi L, Agué C, Dauwalder H P.
Ein Forschungsprogramm über die Rehabilitation psychisch Kranker: I. Konzepte und methodologische Probleme.
Nervenarzt.
1977;
48
12-18
-
29
Ciompi L, Dauwalder H P, Agué C.
Ein Forschungsprogramm zur Rehabilitation psychisch Kranker: III. Längsschnittuntersuchungen zum Rehabilitationserfolg und zur Prognostik.
Nervenarzt.
1979;
50
366-378
-
30 Jung E, Krumm B, Biel H, Maurer K, Bauer-Schubart C. Disability Assessment Schedule (DAS-M): Mannheimer Skala zur Einschätzung sozialer Behinderung. In: Collegium Internationale Psychiatriae Scalarum (CIPS) (Hrsg) Internationale Skalen für Psychiatrie. Weinheim; Beltz 1989
-
31 Krampen G. IPC-Fragebogen zu Kontrollüberzeugungen: Handanweisungen. Göttingen; Hogrefe 1981
-
32 Deusinger I. Die Frankfurter Selbstkonzeptskalen (FSKN). Göttingen; Hogrefe 1986
-
33 Janke W, Erdmann G, Kallus W. Stressverarbeitungsfragebogen (SVF). Göttingen; Hofgrefe 1985
-
34
Strauss J S, Carpenter W T.
The prediction of outcome in schizophrenia. 1. Characteristics of outcome.
Archives of General Psychiatry.
1972;
27
739-746
-
35 SAS Institute Inc. SAS/STAT .User's Guide, Version 8. Cary, NC; SAS Institute Inc 2000
-
36
Carpenter W T, Strauss J S.
The prediction of outcome in schizophrenia IV: Eleven-year follow-up of the Washington IPSS cohort.
Journal of Nervous and Mental Disease.
1991;
179
517-525
-
37
Arns P G, Linney J A.
Relating funtional skills of severely mentally ill clients to subjective and societal benefits.
Psychiatric Services.
1995;
46
260-265
-
38
Mueser K T, Salyers M P, Mueser P R.
A prospective analysis of work in schizophrenia.
Schizophrenia Bulletin.
2001;
27
281-296
-
39
Pogue-Geile M F, Harrow M.
Negative and positive symptoms in schizophrenia and depression: A follow-up.
Schizophrenia Bulletin.
1985;
10
371-387
-
40
Massel H K, Liberman R P, Mintz J. et al .
Evaluating the capacity to work of the mentally ill.
Psychiatry.
1990;
53
31-43
-
41
Fenton W S, McGlashan T H.
Natural history of schizophrenia subtypes: II. Positive and negative symptoms.
Archives of General Psychiatry.
1991;
48
978-986
-
42
Glynn S, Randolph E, Eth S, Paz G, Leong G, Shaner A, VanVort W.
Schizophrenic symptoms, work adjustment, and behavioral family therapy.
Rehabilitation Psychology.
1992;
37
323-338
-
43
Solinski S, Jackson H J, Bell R C.
Prediction of employability in schizophrenic patients.
Schizophrenia Research.
1992;
7
141-148
-
44
Lysaker P H, Bell M D.
Negative symptoms and vocational impairment in schizophrenia: Repeated measurements of work performance over six months.
Acta Psychiatrica Scandinavica.
1995;
91
205-208
-
45
McGurk S R, Meltzer H Y.
The role of cognition in vocational functioning in schizophrenia.
Schizophrenia Research.
2000;
45
175-184
-
46
Jackson H J, Minas I H, Burgess P M. et al .
Is social skills performance a correlate of schizophrenia subtypes?.
Schizophrenia Research.
1989a;
2
301-309
-
47
Jackson H J, Minas I H, Burgess P M. et al .
Negative symptoms and social skills performance in schizophrenia.
Schizophrenia Research.
1989b;
2
457-463
-
48
Bellack A S, Morrison R L, Wixted J T, Mueser K T.
An analysis of social competence in schizophrenia.
British Journal of Psychiatry.
1990;
156
809-818
-
49
Mueser K T, Bellack A S, Morrison R L, Wixted J T.
Social competence in schizophrenia: Premorbid adjustment, social skill, and domains of functioning.
Journal of Psychiatric Research.
1990;
24
51-63
-
50
Halford W K, Hayes R L.
Social skills in schizophrenia: Assessing the relationship between social skills, psychopathology and community functioning.
Social Psychiatry and Psychiatric Epidemiology.
1995;
30
14-19
-
51
Silverstein M L, Fogg L, Harrow M.
Prognostic significance of cerebral status: Dimensions of clinical outcome.
Journal of Nervous and Mental Diseases.
1991;
179
534-539
-
52
Lysaker P H, Bell M D, Beam-Goulet J.
Wisconsin Card Sorting Test and work performance in schizophrenia.
Psychiatry Research.
1995;
56
45-51
-
53
Brekke J S, Raine A, Ansel M, Lencz T, Bird L.
Neuropsychological and psychophysiological correlates of psychosocial functioning in schizophrenia.
Schizophrenia Bulletin.
1997;
23
19-28
-
54
Regenold M, Sherman M F, Fenzel M.
Getting back to work: Self-efficacy as a predictor of employment outcome.
Psychiatric Rehabilitation Journal.
1999;
22
361-367
PD Dr. med. Holger Hoffmann
Abteilung Sektorisierte Gemeindepsychiatrie · Universitätsklinik für Sozial- und Gemeindepsychiatrie Bern
Laupenstraße 49
Postfach 52
3000 Bern 10 · Schweiz
eMail: hoffmann@spk.unibe.ch
