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Psychiatr Prax 2008; 35(6): 271-278
DOI: 10.1055/s-2007-986351
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Arbeitsrehabilitation psychisch kranker Menschen – ein Überblick über Erfolgsprädiktoren

Vocational Rehabilitation for Mentally Ill Persons – An Overview of Predictors for Successful IntegrationTeresa  Matschnig1 , Patrick  Frottier2 , Michaela-Elena  Seyringer1 , Stefan  Frühwald3
  • 1Universitätsklinik für Psychiatrie und Psychotherapie, Medizinische Universität Wien
  • 2Justizanstalt Mittersteig, Wien
  • 3Psychosozialer Dienst der Caritas St. Pölten
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Publication History

Publication Date:
27 May 2008 (online)

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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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 4 Mueser K T, Salyers M P, Mueser P R. A prospective analysis of work in schizophrenia.  Schizophr Bull. 2001;  27 281-296
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 14 Marhawa S, Johnson S. Schizophrenia and employment.  Soc Psychiatry Psychiatr Epidemiol. 2004;  39 337-349
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 25 Richter A, Blaha L, Groß W, Schreiber W. Prädiktion des beruflichen Erfolges bei schizophren Erkrankten.  Psychiat Prax. 2004;  31, Supplement 1 S35-S37
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 29 Fabian E S. Supported employment and the quality of life: Does a job make a difference?.  Rehabil Counsel Bull. 1992;  36 84-97
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Rogers E S, Anthony W A, Toole J, Brown M A. Vocational outcomes following psychosocial rehabilitation.  J Vocational Rehabilitation. 1991;  1 21-29
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 42 Reker T, Eikelmann B. Prädiktoren einer erfolgreichen beruflichen Eingliederung.  Psychiat Prax. 1999;  26 218 - 223
    PubMedGoogle Scholar
  • 43 Hoffmann H, Kupper Z. Prädiktive Faktoren einer erfolgreichen beruflichen Wiedereingliederung von schizophrenen Patienten.  Psychiat Prax. 2003;  30 312-317
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 46 Bell M D, Bryson G. Work rehabilitation in schizophrenia: does cognitive impairment limit improvement?.  Schizophr Bull. 2001;  27 269-279
    PubMedGoogle Scholar
  • 47 Lysaker P, Bell M, Beam-Goulet J. Wisconsin card sorting test and work performance in schizophrenia.  Psychiatr Res. 1995;  56 45-51
    CrossrefPubMedGoogle Scholar
  • 48 Mecklenburg H. Zwölf Thesen für eine langfristig erfolgreiche berufliche Integration psychisch Kranker und Behinderter.  Psychiat Prax. 1999;  26 227-232
    PubMedGoogle Scholar
  • 49 Reker T. Krankheits- und Rehabilitationsverläufe schizophrener Patienten in ambulanter Arbeitstherapie.  Nervenarzt. 1998;  69 210-218
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 56 Rose V, Perz J. Is CBT useful in vocational rehabilitation for people with a psychiatric disability?.  Psychiatr Rehabil J. 2005;  29 56-58
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 58 Wexler B E, Bell M D. Cognitive remediation and vocational rehabilitation for schizophrenia.  Schizophr Bull. 2005;  31 931-941
    CrossrefPubMedGoogle Scholar
  • 59 Hoffmann H. Berufliche Rehabilitation. In: Rössler W Psychiatrische Rehabilitation. Heidelberg; Springer 2004: 333-346
    Google Scholar
  • 60 Rössler W. Perspektiven der psychiatrischen Rehabilitation.  Psychiatrie & Psychotherapie. 2007;  3 3-8
    PubMedGoogle Scholar
  • 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
    Article in Thieme ConnectPubMedGoogle Scholar

Univ.-Doz. Dr. Stefan Frühwald

Psychosozialer Dienst der Caritas St. Pölten

Dr. Karl-Renner Promenade 12

3100 St. Pölten, Österreich

Email: psd.fruehwald@stpoelten.caritas.at

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