Purpose

To investigate longitudinal trajectories of vocational recovery (VR) among individuals with severe mental illness (SMI) who participated in the Danish Individual Placement and Support (IPS) trial, and whether the IPS intervention, socio-demographic and disease-specific characteristics predicted trajectory membership.

Methods

In an observational study design, we used previously collected data from the Danish IPS trial (N = 720). VR was defined as ‘weeks in competitive employment or education in the past 6 months and was measured after 0.5, 1, 1.5, 2 and 2.5 years, using data from the Danish Register for Evaluation of Marginalization (DREAM) database. Latent growth mixture modelling in Mplus statistical software (version 7) was applied to identify trajectories of VR. Multinomial logistic regression analyses were used to estimate predictors for trajectory membership.

Results

Four trajectories were identified: ‘Low VR’ (61.3%), ‘Low Increasing VR (8.2%), ‘Increasing Decreasing VR’ (7.2%) and ‘High VR’ (23.4%). Receiving the IPS intervention increased odds of membership in ‘High VR’ compared to ‘Low VR’ (OR = 2.18; 95% CI 1.37–3.48) and so did higher education (OR = 2.25; 95% CI 1.39–3.64), higher cognitive function (OR = 1.17; 95% CI 1.02–1.35), higher motivation to change (OR = 1.04; 95% CI 1.02–1.05) and previous work history (OR = 1.64; 95% CI 1.09–2.46). Higher age decreased odds of membership in the ‘High VR’ (OR = 0.95; 95% CI 0.93–0.98) compared to ‘Low VR’.

Conclusion

There was high heterogeneity in the identified VR trajectories, despite that all participants expressed a desire for work and education at baseline. Improvements of the IPS intervention are needed to support specific groups in achieving and retaining employment.

中文翻译：

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在丹麦参加个人安置和支持 (IPS) 的随机三组优势试验的严重精神疾病患者的职业康复轨迹

目的

调查参加丹麦个人安置和支持 (IPS) 试验的严重精神疾病 (SMI) 个体的职业康复 (VR) 纵向轨迹，以及 IPS 干预、社会人口和疾病特异性特征是否预测轨迹成员资格.

方法

在一项观察性研究设计中，我们使用了之前从丹麦 IPS 试验 (N = 720) 收集的数据。VR 被定义为“过去 6 个月内从事竞争性就业或教育的周数，并在 0.5、1、1.5、2 和 2.5 年后使用来自丹麦边缘化评估登记 (DREAM) 数据库的数据进行测量。应用 Mplus 统计软件（第 7 版）中的潜在生长混合物建模来识别 VR 的轨迹。多项逻辑回归分析用于估计轨迹成员的预测因子。

结果

确定了四个轨迹：“低 VR”（61.3%）、“低增加 VR”（8.2%）、“增加减少 VR”（7.2%）和“高 VR”（23.4%）。与“低 VR”相比，接受 IPS 干预增加了“高 VR”成员的几率（OR = 2.18；95% CI 1.37–3.48），高等教育也是如此（OR = 2.25；95% CI 1.39–3.64），更高认知功能（OR = 1.17；95% CI 1.02–1.35）、更高的改变动机（OR = 1.04；95% CI 1.02–1.05）和以前的工作经历（OR = 1.64；95% CI 1.09–2.46）。与“低 VR”相比，较高的年龄降低了“高 VR”成员的几率（OR = 0.95；95% CI 0.93–0.98）。

结论

尽管所有参与者在基线时都表达了对工作和教育的渴望，但已确定的 VR 轨迹存在高度异质性。需要改进 IPS 干预以支持特定群体实现和保持就业。