Abstract
Poor vocational engagement is well documented among young people experiencing first-episode psychosis (FEP). The aim of the present study was to establish and compare rates of vocational engagement across young people with first-episode psychosis, depression, and borderline personality pathology. A file audit was used to collect vocational data of young people aged 15–25 entering tertiary mental health treatment in 2011. Rates of vocational engagement were similar across groups, indicating that like those with FEP, young people with depression and borderline personality pathology experience impaired vocational engagement and are in need of targeted vocational interventions. Post hoc analysis indicated that that the depression group had significantly more people who were partially vocationally engaged compared with the psychosis group, suggesting that vocational interventions might need to be targeted differently across different diagnostic groups. Future research should explore risk factors for vocational disengagement across diagnostic groups in order to inform intervention development.
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References
ACAMH Special Interest Group in Youth Mental Health. (2013). The International Declaration on Youth Mental Health. Retrieved from http://www.iaymh.org/f.ashx/8909_Int-Declaration-YMH_print.pdf.
Albert, N., Bertelsen, M., Thorup, A., Petersen, L., Jeppesen, P., Le Quack, P., et al. (2011). Predictors of recovery from psychosis analyses of clinical and social factors associated with recovery among patients with first-episode psychosis after 5 years. Schizophrenia Research, 125(2–3), 257–266. https://doi.org/10.1016/j.schres.2010.10.013.
Allen, N. B., Hetrick, S. E., Simmons, J. G., & Hickie, I. B. (2007). Early intervention for depressive disorders in young people: The opportunity and the (lack of) evidence. Medical Journal of Australia, 187(7 Suppl), S15-S17.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th edn.). Arlington, VA: American Psychiatric Publishing.
Andrews, G., & Wilkinson, D. D. (2002). The prevention of mental disorders in young people. Medical Journal of Australia, 177(7), S97.
Birchwood, M., & Fiorillo, A. (2000). The critical period for early intervention. Psychiatric Rehabilitation Skills, 4(2), 182–198. https://doi.org/10.1080/10973430008408405.
Chanen, A. M., Jovev, M., McCutcheon, L. K., Jackson, H. J., & McGorry, P. D. (2008). Borderline personality disorder in young people and the prospects for prevention and early intervention. Current Psychiatry Reviews, 4(1), 48–57. https://doi.org/10.2174/157340008783743820.
Chanen, A. M., & McCutcheon, L. (2013). Prevention and early intervention for borderline personality disorder: Current status and recent evidence. British Journal of Psychiatry Supplement, 54, s24–s29. https://doi.org/10.1192/bjp.bp.112.119180.
Chanen, A. M., McCutcheon, L., & Kerr, I. B. (2014). HYPE: A cognitive analytic therapy-based prevention and early intervention programme for borderline personality disorder. In C. Sharp & J. L. Tackett (Eds.), Handbook of borderline personality disorder in children and adolescents (pp. 361–383). New York, NY: Springer.
Cooper, C. L., & Lu, L. (2016). Presenteeism as a global phenomenon: Unraveling the psychosocial mechanisms from the perspective of social cognitive theory. Cross Cultural & Strategic Management, 23(2), 216–231. https://doi.org/10.1108/CCSM-09-2015-0106.
First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). User’s guide for the structured clinical interview for DSM-IV Axis II personality disorders. Washington,DC: American Psychiatric Press.
Fraser, R., Berger, G., Killackey, E., & McGorry, P. (2006). Emerging psychosis in young people-part 3: Key issues for prolonged recovery. Australian Family Physician, 35(5), 329–333.
Gowers, S., Harrington, R., Whitton, A., Lelliott, P., Beevor, A., Wing, J., & Jezzard, R. (1999). Brief scale for measuring the outcomes of emotional and behavioural disorders in children. Health of the Nation Outcome Scales for children and Adolescents (HoNOSCA). The British Journal of Psychiatry, 174(5), 413–416. https://doi.org/10.1192/bjp.174.5.413.
Jackson, H. J., & McGorry, P. D. (Eds.). (2009). The recognition and management of early psychosis: A preventative approach (Second edn.). New York: Cambridge University Press.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.
Killackey, E., Jackson, H., Gleeson, J., Hickie, I., & McGorry, P. (2006). Exciting career opportunity beckons! Early intervention and vocational rehabilitation in first-episode psychosis: Employing cautious optimism. Australian and New Zealand Journal of Psychiatry, 40(11–12), 951–962. https://doi.org/10.1080/j.1440-1614.2006.01918.x.
Killackey, E., Jackson, H. J., & McGorry, P. D. (2008). Vocational intervention in first-episode psychosis: individual placement and support v. treatment as usual. The British Journal of Psychiatry, 193(2), 114–120. https://doi.org/10.1192/bjp.bp.107.043109.
Kroenke, K., & Spitzer, R. L. (2002). The PHQ-9: A new depression diagnostic and severity measure. Psychiatric annals, 32(9), 509–515. https://doi.org/10.3928/0048-5713-20020901-06.
Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: Systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445–452. https://doi.org/10.1192/bjp.bp.110.083733.
Major, B. S., Hinton, M. F., Flint, A., Chalmers-Brown, A., McLoughlin, K., & Johnson, S. (2010). Evidence of the effectiveness of a specialist vocational intervention following first episode psychosis: A naturalistic prospective cohort study. Social Psychiatry and Psychiatric Epidemiology, 45(1), 1–8. https://doi.org/10.1007/s00127-009-0034-4.
Marwaha, S., & Johnson, S. (2004). Schizophrenia and employment. Social Psychiatry and Psychiatric Epidemiology, 39(5), 337–349. https://doi.org/10.1007/s00127-004-0762-4.
McGorry, P. D., Edwards, J., Mihalopoulos, C., Harrigan, S. M., & Jackson, H. J. (1996). EPPIC: An evolving system of early detection and optimal management. Schizophrenia Bulletin, 22(2), 305.
Merry, S. N. (2007). Prevention and early intervention for depression in young people–a practical possibility? Current Opinion in Psychiatry, 20(4), 325–329. https://doi.org/10.1097/YCO.0b013e3281bc0d19.
Morgan, C., Charalambides, M., Hutchinson, G., & Murray, R. M. (2010). Migration, ethnicity, and psychosis: Toward a sociodevelopmental model. Schizophrenia Bulletin. https://doi.org/10.1093/schbul/sbq051.
O’Dea, B., Lee, R. S., McGorry, P. D., Hickie, I. B., Scott, J., Hermens, D. F., et al. (2016). A prospective cohort study of depression course, functional disability, and NEET status in help-seeking young adults. Social Psychiatry and Psychiatric Epidemiology, 51(10), 1395–1404. https://doi.org/10.1007/s00127-016-1272-x.
Organisation for Economic Co-operation and Development (OECD). (2011). Education at a glance 2011: OECD Indicators. OECD Publishing. https://dx.doi.org/10.1787/eag-2011-en.
Organisation for Economic Co-operation and Development (OECD). (2012). OECD employment outlook 2012. Paris: OECD Publishing. https://dx.doi.org/10.1787/empl_outlook-2012-en.
Organisation for Economic Co-operation and Development (OECD). (2015). Mental health and work: Australia. Paris: OECD Publishing. https://dx.doi.org/10.1787/9789264246591-en.
Organisation for Economic Co-operation and Development (OECD). (2017). Youth unemployment rate (indicator). https://dx.doi.org/10.1787/c3634df7-en. Retrieved 5 Jan 2017.
Rice, S. M., Halperin, S., Cahill, S., Cranston, I., Phelan, M., Hetrick, S. E., et al. (2017). The Youth Mood Clinic: An innovative service for the treatment of severe and complex depression. Australasian Psychiatry, 25(2), 112–116.
Sio, I. T., Chanen, A. M., Killackey, E. J., & Gleeson, J. (2011). The relationship between impulsivity and vocational outcome in outpatient youth with borderline personality features. Early Intervention in Psychiatry, 5(3), 249–253. https://doi.org/10.1111/j.1751-7893.2011.00271.x.
Viera, A. J., & Garrett, J. M. (2005). Understanding interobserver agreement: The kappa statistic. Family Medicine, 37(5), 360–363.
Waghorn, G., Chant, D., Lloyd, C., & Harris, M. (2011). Earning and learning among Australian community residents with psychiatric disorders. Psychiatry Research, 186(1), 109–116. https://doi.org/10.1016/j.psychres.2010.07.037.
Waghorn, G., & Lloyd, C. (2005). The employment of people with mental illness. Advances in Mental Health, 4(2), 129–171. https://doi.org/10.5172/jamh.4.2.129.
Whooley, M. A., Kiefe, C. I., Chesney, M. A., Markovitz, J. H., Matthews, K., & Hulley, S. B. (2002). Depressive symptoms, unemployment, and loss of income: The CARDIA Study. Archives of Internal Medicine, 162(22), 2614–2620. https://doi.org/10.1001/archinte.162.22.2614.
Wing, J., Beevor, A., Curtis, R., Park, S., Hadden, S., & Burns, A. (1998). Health of the Nation Outcome Scales (HoNOS). Research and development. The British Journal of Psychiatry, 172(1), 11–18. https://doi.org/10.1192/bjp.172.1.11.
Workplace Gender Equality Agency. (2014). Gender workplace statistics at a glance. Retrieved from https://www.wgea.gov.au/sites/default/files/Stats_at_a_glance.pdf.
Funding
Specific funding provided for the development of this manuscript was obtained via E. Caruana’s Doctor of Clinical Psychology budget from La Trobe University. E. Caruana is supported by an Australian Postgraduate Award from La Trobe University. S. M. Cotton, E. Killackey and C. G. Davey are each supported by a Career Development Fellowship from the National Health and Medical Research Council (1061998, 1051891, and 1061757, respectively). E. M. Parrish was supported by a Presidential Global Scholarship from Northeastern University. A. Chanen is supported by the National Health and Medical Research Council. K. Allott is supported by the Ronald Philip Griffiths Fellowship from the Faculty of Medicine Dentistry and Health Sciences, The University of Melbourne.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
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Caruana, E., Cotton, S.M., Farhall, J. et al. A Comparison of Vocational Engagement Among Young People with Psychosis, Depression and Borderline Personality Pathology. Community Ment Health J 54, 831–841 (2018). https://doi.org/10.1007/s10597-017-0197-5
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DOI: https://doi.org/10.1007/s10597-017-0197-5