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Vocational Outcomes of the Individual Placement and Support Model in Subgroups of Diagnoses, Substance Abuse, and Forensic Conditions: A Systematic Review and Analysis of Pooled Original Data

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Abstract

Purpose

To investigate the effect of Individual Placement and Support (IPS) according to diagnoses of schizophrenia, bipolar disorder, major depression, substance use disorders, or forensic psychiatric conditions.

Methods

A systematic search of the literature was conducted in June 2017 and repeated in December 2020. The systematic review included 13 studies. Analyses of pooled original data were based on the six studies providing data (n = 1594). No studies on forensic psychiatric conditions were eligible. Hours and weeks worked were analyzed using linear regression. Employment, and time to employment was analyzed using logistic regression, and cox-regression, respectively.

Results

The effects on hours and weeks in employment after 18 months were comparable for participants with schizophrenia, and bipolar disorder but only statistically significant for participants with schizophrenia compared to services as usual (SAU) (EMD 109.1 h (95% CI 60.5–157.7), 6.1 weeks (95% CI 3.9–8.4)). The effect was also significant for participants with any drug use disorder (121.2 h (95% CI 23.6–218.7), 6.8 weeks (95% CI 1.8–11.8)). Participants with schizophrenia, bipolar disorder, and any drug use disorder had higher odds of being competitively employed (OR 2.1 (95% CI 1.6–2.7); 2.4 (95% CI 1.3–4.4); 3.0 (95% CI 1.5–5.8)) and returned to work faster than SAU (HR 2.1 (95% CI 1.6–2.6); 1.8 (95% CI 1.1–3.1); 3.0 (95% CI 1.6–5.7)). No statistically significant effects were found regarding depression.

Conclusions

IPS was effective regarding schizophrenia, bipolar disorder, and substance use disorder; however, the effect on hours, and weeks worked was not statistically significant regarding bipolar disorder. For people with depression the impact of IPS remains inconclusive. Non-significant results may be due to lack of power.

Trial Registration: PROSPERO protocol nr. CRD42017060524

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Data Availability

Data from the study is only available on request due to privacy/ethical restrictions.

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Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. CORE: Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 2900, Hellerup, Denmark

    Lone Hellström, Thomas Nordahl Christensen, Anders Bo Bojesen & Lene Falgaard Eplov

  2. Department of Public Health, Aarhus University, Aarhus, Denmark

    Pernille Pedersen

  3. DEFACTUM, Central Denmark Region, Aarhus, Denmark

    Pernille Pedersen

  4. Institute of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

    Thomas Nordahl Christensen

  5. Research Unit of Mental Health, Odense, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark

    Iben Gammelgaard Wallstroem

  6. Research Unit of Mental Health, Aabenraa, Institute of Regional Health Services, University of Southern Denmark, Odense, Denmark

    Elsebeth Stenager

  7. Department Health Sciences, Lund University, Lund, Sweden

    Ulrika Bejerholm

  8. University Medical Center Groningen, Groningen, Netherlands

    Jooske van Busschbach

  9. University Center of Psychiatry, Groningen, Netherlands

    Jooske van Busschbach

  10. Department of Movement and Education, Windesheim University of Applied Sciences, Zwolle, Netherlands

    Jooske van Busschbach

  11. Trimbos Institute, Utrecht, Netherlands

    Harry Michon

  12. Center for Psychiatric Rehabilitation, Boston University, Boston, USA

    Kim T. Mueser

  13. Department of Psychology, University of Oslo, Oslo, Norway

    Silje Endresen Reme

  14. Population Health Research Institute St George’s, University of London, London, UK

    Sarah White

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  1. Lone Hellström
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Contributions

LFE, TNC, IGW, PP, ABB, ES, and LH participated in the planning and design of the study. TNC, IGW, UB, JvB, HM, KTM, SER, SW provided data for the review. PP and LH reviewed the literature. ABB conducted the analyses and drafting of figures and tables. ABB, PP and LH wrote the manuscript. All authors have participated in the interpretation of the results and have read and critically revised the manuscript.

Corresponding author

Correspondence to Lone Hellström.

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Included studies were all performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Hellström, L., Pedersen, P., Christensen, T.N. et al. Vocational Outcomes of the Individual Placement and Support Model in Subgroups of Diagnoses, Substance Abuse, and Forensic Conditions: A Systematic Review and Analysis of Pooled Original Data. J Occup Rehabil 31, 699–710 (2021). https://doi.org/10.1007/s10926-021-09960-z

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