Background: Employment among adults with severe and persistent mental illness is a major concern for the field of vocational rehabilitation. Many studies have examined factors associated with successful vocational experiences among members of this population, but there are few meta-analytic studies that can be used to identify variables that may be associated with work success for people with psychiatric disabilities. Objectives: To review existing literature on employment outcomes and identify studies that include demographic (age, race, gender) and diagnostic variables (schizophrenia or affective disorder), then to conduct meta-analyses of those studies that report the degree of association between these variables and employment outcomes. Search strategy: The authors searched MEDLINE, PsychINFO, and Web of Science between the years 1989-2001. The authors also reviewed the reference lists of articles and conducted a hand search of 15 journals in the mental health and vocational area. Selection criteria: Articles were considered for inclusion that met the following criteria: 1) the study reported data on a sample of persons with severe and persistent mental illness in the United States; 2) reported data included age, race, gender, and/or diagnosis; 3) the study included a measure of vocational outcome; and 4) reported demographic and vocational outcome data that could be extracted for meta-analysis. Data collection and analysis: 17 empirical research studies met the inclusion criteria. The authors coded each study on methodological, client, and outcome variables. Main Results: Younger people are significantly more likely to be employed. Caucasians are significantly more likely than persons of color to attain employment. Persons diagnosed with schizophrenia generally have poorer vocational outcomes than persons with other diagnoses. Persons diagnosed with affective disorders generally have better vocational outcomes than others. Persons of color are significantly more likely than Caucasians to be employed 6 months after placement. Conclusions: There may be a need for specific policies and services that address the unique needs of persons who are older, that promote employment opportunities for persons of color, and that recognize and address possible differences between individuals with schizophrenia and individuals with affective disorders in terms of their employment needs, their opportunities for employment, and their ability to sustain employment. Since some of the differences found between subgroups reflect well-known inequities in the larger society, change may be needed in social policies, services systems, program practices and public attitudes that differentially affect the vocational outcomes of various demographic and diagnostic subgroups. The authors also outline six problems that preclude more extensive use of meta-analysis in the field of psychiatric vocational rehabilitation currently, and make recommendations for changes in research practice that would help to address these problems. |
